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PEG Placement (peg + placement)

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Medical Sciences	100%

Selected Abstracts

REDUCING THE RISK OF PERISTOMAL INFECTION AFTER PEG PLACEMENT

DIGESTIVE ENDOSCOPY, Issue 4 2005
Iruru Maetani
Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective means of enteral nutrition where oral intake is not possible. PEG placement is safe and has now replaced the nasogastric tube in patients who need long-term feeding. Although it is relatively safe with a very low associated mortality, minor complications, especially local and systemic infection, remain a problem. Of these, peristomal wound infections are the most common complication of PEG. In patients indicated for this procedure who are aged and/or frail, this complication may pose a critical problem. In the commonly used pull or push methods for PEG placement, the PEG tube is readily colonized by oropharyngeal bacteria. Infection of the PEG site is considered to be associated with contamination of the PEG catheter. There are important measures that should be taken to prevent peristomal infection. A number of rigorous studies have shown that prophylactic antibiotics are effective in reducing the risk of peristomal infection. As methicillin-resistant Staphylococcus aureus (MRSA) or other resistant organisms are emerging as a major pathogen in peristomal infection, however, currently recommended antibiotic prophylaxis regimens might be inappropriate. Alternative regimens and other approaches to prevent contamination of the PEG tube during the procedure are required. [source]

CLINICAL INVESTIGATION OF UPPER GASTROINTESTINAL HEMORRHAGE AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

DIGESTIVE ENDOSCOPY, Issue 3 2010
Shinji Nishiwaki
Background:, Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG. Patients and Methods:, We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement. Results:, Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement-related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement-related hemorrhage and one patient each with reflux esophagitis and gastric ulcer. Conclusions:, Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube. [source]

REDUCING THE RISK OF PERISTOMAL INFECTION AFTER PEG PLACEMENT

Radiation technique influence on percutaneous endoscopic gastrostomy tube dependence: Comparison between two radiation schemes

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2009
Georges F. Hatoum MD
Abstract Background. Our aim was to determine whether percutaneous endoscopic gastrostomy (PEG) dependence was significantly different between 2 prospective trials with different radiation fractionation schemes. Methods. Stage III or IV locally advanced head and neck squamous cell carcinomas arising from the oral cavity, hypopharynx, oropharynx, nasopharynx, paranasal sinuses, or larynx were treated using hyperfractionation (A-3 protocol) or accelerated fractionation (A-4 protocol) with chemotherapy. Amifostine was administered 15 to 30 minutes preradiation, at a dose of 500 mg/day in both protocols. It was given as an infusion over 5 to 7 minutes (A-3 protocol) or subcutaneously (A-4 protocol). Data regarding PEG placement and removal were collected prospectively. Results. Thirty-five evaluable A-3 protocol patients, 14 evaluable A-4 protocol patients, and 6 patients treated per A-4 protocol guidelines, but without amifostine as they refused the medication, were included in the analysis. Pretreatment characteristics, such as sex, age, race, T classification, N classification, American Joint Committee on Cancer (AJCC) stage, were compared between the 2 groups of patients. The only significant difference between the 2 groups was AJCC stage. Thirty-five A-3 patients and 20 A-4 patients had overall survivals of 88% versus 80%, 82% versus 75%, and 66% versus 67.5% at 1, 2, and 3 years, respectively (p = .958). With regard to PEG dependence, no significant differences were seen between the 2 groups at 6, 12, or 18 months. Conclusion. PEG dependence was not significantly different between the 2 study groups. Type of altered fractionation scheme may not influence PEG dependence in patients treated with similar protocols. Future randomized studies are needed to confirm these findings. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source]

A systematic review of prophylactic antimicrobials in PEG placement

JOURNAL OF CLINICAL NURSING, Issue 7 2009
Allyson Lipp
Aim., To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies. Background., Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement. Design., Systematic review. Methods., We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. Results., Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0·31, 95% CI 0·22,0·44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5·8 patients to prevent one infection , NNT. Conclusions., Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection. Relevance to clinical practice., The nurse's role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement. [source]

An audit designed to assess the need for planned pretreatment PEG placement in patients with stage III & stage IV oral cancer

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 6 2004
F.R. Dawson
Background:, Nutritional support is a crucial and challenging part of treatment for patients with oral cancer. The aim of this audit was to assess the need for planned pretreatment percutaneous endoscopic gastrostomy (PEG) placement in this group of patients and to assess diet consistency as a predictor of poor outcomes. Method:, This was a retrospective study of 77 consecutive patients with stage III and IV squamous cell carcinoma of the oral cavity treated by radical surgery and post-operative radiotherapy between January 1999 and December 2001. Information was taken from dietitians' records. Patients were divided into two groups according to survival: group 1 (40 patients) comprised nonsurvivors and group 2 (37 patients), survivors. All patients were enterally fed post-operatively. After approximately 10 days, swallowing was assessed and, if deemed competent, patients progressed to a fluid diet. Tube feeding was gradually reduced and then stopped when oral nutrition was sufficient to maintain weight. Patients progressed to soft diet as they were able. During radiotherapy, liquid diet or tube feeding was instigated as required. Results:, In group 1, 65% required tube feeding for less than 30 days (mean 17 days), 20% for 31,100 days (mean 51 days) and 15% for over 100 days (mean 231 days). The overall mean length of tube feeding was 97 days. Thirty-eight per cent of nonsurvivors developed recurrence and went on to subsequent operations necessitating further tube feeding for an average of 129 days. In group 2, 70% were tube fed for less than 30 days (mean 11 days), 14% for between 31,100 days (mean 43 days), and 17% for more than 100 days. The overall mean length of tube feeding was 72 days. The dietary consistency of nonsurvivors was worse than survivors throughout treatment. At first presentation, only 37% of nonsurvivors managed a normal diet, 8% managed a near normal diet and 3% required tube feeding, whereas 48% of survivors managed a normal diet and 16% a near normal diet. At 1 year, there was a significant difference between the two groups' diets. No patients in group 1 managed a normal or near normal diet, whilst 62% required tube feeding. In group 2, 12 and 32% managed a normal and near normal diet, respectively and only 9% required or wished to remain on tube feeding to supplement their diet. Five per cent of patients in this group remained nil by mouth due to fistula. Conclusion:, Deciding whether a patient has a naso-gastric tube, PEG or radiologically inserted gastrostomy tube placed can be a difficult decision. However, a gastrostomy should be considered prior to treatment in patients whose diet is of poor consistency at presentation or who have an inadequate oral intake to maintain or increase weight and in those with a fistula, expected slow recovery of swallowing function, for example, pharyngeal tumour or undergoing brachytherapy or chemoradiotherapy. [source]

Review article: percutaneous endoscopic gastrostomy in infants and children

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010
T. FRÖHLICH
Aliment Pharmacol Ther,31, 788,801 Summary Background, Percutaneous endoscopic gastrostomy (PEG) placement is widely accepted in children needing long-term gastrostomy feeding and clinical experience has been accumulated using PEG in children for nearly three decades. Aim, To discuss the current knowledge about clinical application of percutaneous endoscopic gastrostomy in children as well as associated complications and special aspects. Methods, We reviewed literature on PEG, primarily in children, with a focus on complications, gastro-oesophageal reflux, potential benefits and parental perceptions. In addition to reviewing scientific literature, we considered clinical experience and judgment in developing recommendations for special aspects concerning PEG in children. Results, Since its introduction in 1980, the use of PEG in paediatric patients has become widely accepted. With expanded experience, the number of medical conditions for which PEG is indicated, as well as the use of new techniques has increased. Published reports have helped improve expertise in dealing with associated complications; however, several key issues remain unresolved such as the implications of gastro-oesophageal reflux associated with PEG placement. Conclusions, Percutaneous endoscopic gastrostomy insertion for enteral nutrition in children and adolescents is an efficient and safe technique, even in small children, and is associated with a tolerable complication rate. [source]