CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2020; 11(03): 193-200
DOI: 10.1055/s-0040-1716580
Research Article

Fluoroscopy-Assisted Percutaneous Endoscopic Gastrostomy (F-PEG)—Single-Center Experience and Outcome

Avinash Bhat Balekuduru
1   Department of Gastroenterology, M.S. Ramaiah Hospitals, Bangalore, Karnataka, India
,
Shruti Sagar Bongu
1   Department of Gastroenterology, M.S. Ramaiah Hospitals, Bangalore, Karnataka, India
,
Narendra Babu Mandalapu
1   Department of Gastroenterology, M.S. Ramaiah Hospitals, Bangalore, Karnataka, India
,
Gajendra Ramachandraiah
1   Department of Gastroenterology, M.S. Ramaiah Hospitals, Bangalore, Karnataka, India
,
Vinit Kumar Khemka
1   Department of Gastroenterology, M.S. Ramaiah Hospitals, Bangalore, Karnataka, India
,
Satyaprakash Bonthala Subbaraj
1   Department of Gastroenterology, M.S. Ramaiah Hospitals, Bangalore, Karnataka, India
› Author Affiliations
Funding No grants were received for the study.

Abstract

Background Gastrointestinal route is considered for feeding in subjects who are unable to swallow, either as a temporary or permanent option. Percutaneous endoscopic gastrostomy (PEG) is the preferred mode for long-term enteral nutrition. The aim was to study the outcome of protocol-based PEG placement in a tertiary medical center.

Materials and Methods All the patients who underwent PEG placement between January 2017 and December 2019 were included in the retrospective study. Study variables were entered into a uniform structured proforma. The procedure was done by two people using Ponsky-Gauderer pull-technique. Fluoroscopy guidance was considered for placement in special situations. Post-procedure, all the patients were regularly followed as per protocol to evaluate for adverse events.

Results One hundred and eighteen patients with placement of PEG were included in the study. The mean age of the patients was 49.6 ± 7 years with 67.8% males. The most common indication of PEG was inability to swallow associated with head injury (43, 36.4%), followed by carcinoma esophagus (35, 29.8%) and stroke (24, 20.3%). Fluoroscopy was useful in 38 (32%) for PEG site identification. Tube dislodgement (16, 13.5%) and aspiration pneumonia (20, 16.9%) were the common adverse events. Age more than 60 years and dysphagia in neurologic disorders accounted for more than 60% of adverse events. Forty-nine (42%) of the PEG patients expired due to either primary illness or due to sepsis after a median time of 139 days (range: 32–288 days). There was no difference in the survival in patients with or without PEG-related complications (p = 0. 74).

Conclusions Fluoroscopy assistance helps in accurate PEG placement in one third. Age > 60 years and dysphagia in neurologic disorders were independent risk factors associated with PEG tube complications.



Publication History

Article published online:
16 September 2020

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Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15 (06) 872-875
  • 2 Gordon C, Hewer RL, Wade DT. Dysphagia in acute stroke. Br Med J (Clin Res Ed) 1987; 295 (6595) 411-414
  • 3 Gomes Jr CA, Lustosa SA, Matos D, Andriolo RB, Waisberg DR, Waisberg J. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev 2010; 11 (11) CD008096
  • 4 Moran BJ, Taylor MB, Johnson CD. Percutaneous endoscopic gastrostomy. Br J Surg 1990; 77 (08) 858-862
  • 5 Gauderer M. Twenty years of percutaneous endoscopic gastrostomy: origin and evolution of a concept and its expanded applications. Gastrointest Endosc 1999; 50 (06) 879-883
  • 6 DeLegge MH. Enteral access and associated complications. Gastroenterol Clin North Am 2018; 47 (01) 23-37
  • 7 Prabhakaran S, Doraiswamy VA, Nagaraja V. et al. Nasoenteric tube complications. Scand J Surg 2012; 101 (03) 147-155
  • 8 Wicks C, Gimson A, Vlavianos P. et al. Assessment of the percutaneous endoscopic gastrostomy feeding tube as part of an integrated approach to enteral feeding. Gut 1992; 33 (05) 613-616
  • 9 Mellinger JD, Ponsky JL. Percutaneous endoscopic gastrostomy: state of the art, 1998. Endoscopy 1998; 30 (02) 126-132
  • 10 Pearce CB, Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J 2002; 78 (918) 198-204
  • 11 Niv Y, Abuksis G. Indications for percutaneous endoscopic gastrostomy insertion: ethical aspects. Dig Dis 2002; 20 (3-4) 253-256
  • 12 Hucl T, Spicak J. Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol 2016; 30 (05) 769-781
  • 13 Onder A, Kapan M, Arikanoglu Z. et al. Percutaneous endoscopic gastrostomy: mortality and risk factors for survival. Gastroenterol Res 2012; 5 (01) 21-27
  • 14 Jain R, Maple JT, Anderson MA. et al. ASGE Standards of Practice Committee. The role of endoscopy in enteral feeding. Gastrointest Endosc 2011; 74 (01) 7-12
  • 15 Dobos S, Thill V, Deressa BK. et al. Gastrostomy placement: when fluoroscopy helps the endoscopist. Acta Gastroenterol Belg 2018; 81 (04) 525-527
  • 16 Zenitani M, Uehara S, Nara K. et al. Fluoroscopy-guided percutaneous endoscopic gastrostomy in children: a simple and safe technique. Surg Laparosc Endosc Percutan Tech 2016; 26 (02) 167-170
  • 17 Verma S, Dutta U. Percutaneous endoscopic gastrostomy: an effective yet underutilized procedure in India. Journal of Digestive Endoscopy 2019; 10 (03) 155-157
  • 18 Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014; 20 (24) 7739-7751
  • 19 Balekuduru A, Kumar A, Dutta AK, Aravind H, Subbaraj SB. Feasibility and safety assessment of home based gastrostomy tube feed - a tertiary care centre experience. Trop Gastroenterol 2018; 39 (02) 83-86
  • 20 Pih GY, Na HK, Hong SK. et al. Clinical outcomes of percutaneous endoscopic gastrostomy in the surgical intensive care unit. BMC Gastroenterol 2018; 18 (01) 101
  • 21 Cyrany J, Rejchrt S, Kopacova M, Bures J. Buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy. World J Gastroenterol 2016; 22 (02) 618-627
  • 22 Jain NK, Larson DE, Schroeder KW. et al. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy. A prospective, randomized, double-blind clinical trial. Ann Intern Med 1987; 107 (06) 824-828
  • 23 Krishna S, Singh S, Dinesh KR, Kp R, Siyad I, Karim S. Percutaneous endoscopic gastrostomy (PEG) site infections: a clinical and microbiological study from university teaching hospital, India. J Infect Prev 2015; 16 (03) 113-116
  • 24 Enestvedt BK, Jorgensen J, Sedlack RE. et al. ASGE Training Committee 2013-2014. Endoscopic approaches to enteral feeding and nutrition core curriculum. Gastrointest Endosc 2014; 80 (01) 34-41
  • 25 Shangab MO, Shaikh NA. Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study. Ann Gastroenterol 2019; 32 (05) 469-475
  • 26 Prosser B. Common issues in PEG tubes–what every fellow should know. Gastrointest Endosc 2006; 64 (06) 970-972
  • 27 Heyland DK. Nutritional support in the critically ill patients. A critical review of the evidence. Crit Care Clin 1998; 14 (03) 423-440
  • 28 Selim Youssef GY, Alnajjar A, Elsherbiny M. A comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in prolonged dysphagic stroke patients. Adv Arab Acad Audio-Vestibul J 2015; 2: 14-18
  • 29 Karthikumar B, Keshava SN, Moses V, Chiramel GK, Ahmed M, Mammen S. Percutaneous gastrostomy placement by intervention radiology: Techniques and outcome. Indian J Radiol Imaging 2018; 28 (02) 225-231
  • 30 Shukla PA, Kolber MK, Tapnio R, Zybulewski A, Kumar A, Patel RI. Safety and feasibility of ultrasound-guided gastric access for percutaneous transabdominal gastrostomy tube placement. Gastroenterol Res 2019; 12 (03) 115-119
  • 31 Fukita Y, Katakura Y, Adachi S. et al. Colonoscopy-assisted percutaneous endoscopic gastrostomy to avoid a gastrocolocutaneous fistula of the transverse colon. Endoscopy 2014; 46 (Suppl 1 UCTN) E60
  • 32 Uflacker A, Qiao Y, Easley G. Patrie J, Lambert D, de Lange EE. Fluoroscopy-guided jejunal extension tube placement through existing gastrostomy tubes: analysis of 391 procedures. Diagn Interv Radiol 2015; 21 (06) 488-493
  • 33 Gupta A, Singh AK, Goel D, Gaind AN, Mittal S. Percutaneous endoscopic gastrostomy tube placement: a single center experience. Journal of Digestive Endoscopy 2019; 10 (03) 150-154
  • 34 Geer W, Jeanmonod R. Early presentation of buried bumper syndrome. West J Emerg Med 2013; 14 (05) 421-423
  • 35 Libânio D, Pimentel-Nunes P. Early buried bumper syndrome - to leave or not to leave. GE Port J Gastroenterol 2018; 25 (03) 115-116
  • 36 Naik RP, Joshipura VP, Patel NR, Haribhakti SP. Complications of PEG–prevention and management. Trop Gastroenterol 2009; 30 (04) 186-194
  • 37 Jafri NS, Mahid SS, Minor KS, Idstein SR, Hornung CA, Galandiuk S. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther 2007; 25 (06) 647-656
  • 38 Sanders DS, Carter MJ, D’Silva J, James G, Bolton RP, Bardhan KD. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol 2000; 95 (06) 1472-1475
  • 39 Varnier A, Iona L, Dominutti MC. et al. Percutaneous endoscopic gastrostomy: complications in the short and long-term follow-up and efficacy on nutritional status. Eura Medicophys 2006; 42 (01) 23-26