Complications related to Percutaneous Endoscopic Gastrostomy (PEG) tubes. A comprehensive clinical review

Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA.
Journal of gastrointestinal and liver diseases: JGLD (Impact Factor: 2.2). 01/2008; 16(4):407-18.
Source: PubMed


Percutaneous endoscopic gastrostomy (PEG) has become the modality of choice for providing enteral access to patients who require long-term enteral nutrition. Although generally considered safe, PEG tube placement can be associated with many potential complications. This review describes a variety of PEG tube related complications as well as strategies for complication avoidance. In addition, the reader is presented with a brief discussion of procedures, techniques, alternatives to PEG tubes, and related issues. Special topics covered in this review include PEG tube placement following previous surgery and PEG tube use in pregnancy.

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Available from: Rohit Sharma, Sep 23, 2014
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    • "The incidence rates for serious and minor complication have been estimated to be 3% and 6%, respectively. Immediate mortality after the procedure is less than 1% ( Schrag et al., 2007 ; Vanis, Saray, Gornjakovic, & Mesihovic, 2012 ). Table 2 describes the most common complications, their causes, and measures for resolution. "
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    ABSTRACT: Percutaneous endoscopic gastrostomy (PEG) feeding represents the most effective and safest option for feeding patients with an impaired or diminished swallowing ability, despite having a functioning digestive system. The use of PEG has evolved to be useful in many situations beyond degenerative neuromuscular disorders, with an increasing body of evidence supporting the advantages of PEG tubes in oncologic and pediatric patients. Risk factors for complications after PEG tube placement include acute and chronic conditions associated with malnutrition and several organic disorders. Patients suitable for PEG tube placement should be individually identified to implement the advantages of this technique while minimizing risk events. The safety of placing a PEG tube in patients under antithrombotic medication has been investigated, as well as the advantages of antibiotic prophylaxis in reducing peristomal infection. Evidence supports the safety of early feeding after placement, thus resulting in lower costs. Percutaneous endoscopic gastrostomy-related complications are rare and mostly prevented by appropriate nursing care. Best medical practice and nursing care will ensure optimal performance leading to a wider acceptance, and greater utility of PEG by healthcare professionals, patients, and caregivers. This review aims to update knowledge relating to PEG tube indications, placement, management, and care in order to reinforce PEG feeding as the most valuable access for patients with a functional gastrointestinal system who have abnormalities in swallowing mechanisms.
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    • "This paper demonstrates the application of a fully controllable electropermanent magnetic coupling system between a permanent magnet inside of the porcine stomach and an electropermanent magnet (EPM) for external manipulation. The current realization provides a mechanical working channel alleviating possible ambiguity in current procedures that necessitate trans-abdominal incisions, such as is typical in the placement of percutaneous endoscopic gastrostomy (PEG) tubes [23]. "
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    ABSTRACT: The use of magnets for anchoring of instrumentation in minimally invasive surgery and endoscopy has become of increased interest in recent years. Permanent magnets have significant advantages over electromagnets for these applications; larger anchoring and retraction force for comparable size and volume without the need for any external power supply. However, permanent magnets represent a potential hazard in the operating field where inadvertent attraction to surgical instrumentation is often undesirable. The current work proposes an interesting hybrid approach which marries the high forces of permanent magnets with the control of electromagnetic technology including the ability to turn the magnet off when necessary. This is achieved through the use of an electropermanent magnet, which is designed for surgical retraction across the abdominal and gastric walls. Our electropermanent magnet, which is hand-held and does not require continuous power, is designed with a centre lumen which may be used for trocar or needle insertion. The device in this application has been demonstrated successfully in the porcine model where coupling between an intraluminal ring magnet and our electropermanent magnet facilitated guided insertion of an 18Fr Tuohy needle for guidewire placement. Subsequent investigations have demonstrated the ability to control the coupling distance of the system alleviating shortcomings with current methods of magnetic coupling due to variation in trans-abdominal wall thicknesses. With further refinement, the magnet may find application in the anchoring of endoscopic and surgical instrumentation for minimally invasive interventions in the gastrointestinal tract.
    Full-text · Article · Oct 2014 · IEEE transactions on bio-medical engineering
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    • "Percutaneous endoscopic gastrostomy (PEG) tube placement is most commonly performed for long- term enteral feeding access and/or gastric decompression.1 The PEG procedure was first described by Gauderer and colleagues in 1980 as an effective method of enteral feeding and as an alternative to surgical gastrostomy insertion.2,3 The most frequent indications for PEG include cerebrovascular disease (CVD), motor-neuron disease (MND), cancer, and trauma to the head and neck.4–7 "
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    ABSTRACT: BACKGROUND / OBJECTIVES The aim of this study was to perform a retrospective analysis characterizing patients receiving tube feeding following percutaneous endoscopic gastrostomy ( PEG) tube placement between 2004 and 2012 at Erciyes University Hospital in Turkey. METHODS Patients above the age of 18 years, who required long term enteral tube feeding were studied. All PEGs were performed using the pull-through technique by one experienced endoscopist Demographic, clinical outcomes, and PEG-related complication data were collected. RESULTS Of the 128 subjects studied, 91 were male (71%) and 37 were female (29%). The mean age of this patient population was 54±19 years. The most common reason for PEG tube insertion was inability to consume oral diet due to complications of cerebrovascular disease (CVD; 27%), while cerebral hypoxia, occuring after non-neurological medical disorders, was the second most common indication (23%). A total of 70 patients (55%) had chronic comorbidities, with hypertension the most common (20%). The most common procedure related complication was insertion site bleeding, which occurred in 4 % of patients. Long term complications, during one year were insertion site cellulitis, gastric contents leakage, and peristomal ulceration occurred in 14%, 5%, and 0.5% of patients, respectively. There were no PEG insertion-related mortalities; one-year mortality was unrelated to the indication for PEG tube insertion. CONCLUSIONS PEG tube insertion was a safe method to provide enteral access for nutrition support in this hospitalized patient population.
    Full-text · Article · Feb 2014 · European journal of clinical nutrition
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