Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances (original) (raw)
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International Surgery Journal
Background: The aims and objectives of this article were to compare the advantages, disadvantages associated with percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tube and also to compare complications, to measure the outcomes in terms of hospital stay, mortality and improvement in nutritional status.Methods: In this prospective and interventional study 25 patients were selected in each group on an alternate basis. Study was conducted on cases of traumatic brain injury and cerebrovascular accident patients admitted in Department of General Surgery, IGGMC for a period of November 2013- November 2015 with a need to provide prolonged enteral nutritional support. Each patient was assessed by a dietician and received a standard enteral feeding according to their body weight. The main outcome was measures at 4 weeks were complications (tube dislodgement, aspiration pneumonia, tube blockade and peristomal infections) and nutritional status.Results: The anthropometric paramete...
Clinical Nutrition, 2001
AbstractöObjective: To compare the indications for and the outcome of long-term enteral feeding by nasogastric tube (NGT) with that of percutaneous endoscopic gastrostomy (PEG) tube. Design: A prospective, multicenter cohort study. Setting: Acute geriatric units and long-term care (LTC) hospitals in Jerusalem, Israel. Participants: 122 chronic patients aged 65 years and older for whom long-term enteral feeding was indicated as determined by the treating physician. Patients with acute medical conditions at the time of tube placement were excluded. Measurements: We examined the indications for enteral feeding, nutritional status, outcome and complications in all subjects. Subjects were followed for a minimum period of six months. Results: Although the PEG patients were older and had a higher incidence of dementia, there was an improved survival in those patients with PEG as compared to NGT (hazard ratio (HR) ¼ 0.41; 95% con¢dence interval (CI) 0.22^0.76; P ¼ 0.01). Also, the patients with PEG had a lower rate of aspiration (HR ¼ 0.48; 95% CI 0.26^0.89) and self-extubation (HR ¼ 0.17; 95% CI 0.05^0.58) than those with NGT. Apart from a signi¢cant improvement in the serum albumin level at the 4-week follow-up assessment in the patients with PEG compared to those with NGT (adjusted mean 3.35 compared to 3.08; F ¼ 4.982), nutritional status was otherwise similar in both groups. Conclusion: In long-term enteral feeding, in a selected group of non-acute patients, the use of PEG was associated with improved survival, was better tolerated by the patient and was associated with a lower incidence of aspiration. A randomized controlled study is needed to determine whether PEG is truly superior to NGT.
Cureus
Percutaneous endoscopic gastrostomy (PEG) feeding is a common and widely performed procedure appropriate for long-term enteral nutrition in patients with multiple indications. We present the case of a 59-year-old woman with a PEG tube placed owing to complication following thyroid surgery approximately 20 years ago, representing the most extended duration of PEG tube feeding without any significant complication for chronic mechanical dysphagia. This case highlights the importance of PEG feeding, where this route can be used indefinitely in an appropriate clinical setting without complications. Interestingly, self-replacement of PEG tube was performed by the patient herself whenever she noticed clogging up of tube while selffeeding.
Our experience with percutaneous endoscopic gastrostomy and long-term follow-up results
Anatolian Current Medical Journal, 2022
Aim: Percutaneous endoscopic gastrostomy (PEG) is the preferred method for long-term enteral feeding of patients who cannot be fed orally for various reasons and have a functioning gastrointestinal system. In this study, we aimed to present and discuss the demographic characteristics, indications, and early and late complications of patients implanted with the endoscopic PEG in our center. Material and Method: In this study, we retrospectively evaluated age, gender, chronic diseases, indication for PEG, complications during the procedure, complications arising from PEG during patient follow-up, and survival times of 84 patients who underwent PEG between January 2016 and January 2020 from the electronic medical file system. Results: Of the 84 patients enrolled in the study, 59.5% (n=50) were male and 40.5% (n=34) were female. The mean age of the patients was 61.35±19.52 years. The endoscopic PEG success rate was 97.6%. Of the requests for PEG, 58.6% (n=50) were for patients in intensive care units. The most common indications for PEG insertion were cerebrovascular accident (CVA), chronic nervous system disease, and hypoxic-ischemic encephalopathy. Complications related to PEG were observed in 11 patients. All complications were mild, and no severe complications were observed. While one of the complications developed in the early period (<30 days), the other complications occurred in the long term (> 30 days). No deaths from causes related to the PEG procedure have been observed. Conclusion: In patients with inadequate oral intake, PEG is a safe and appropriate option for continuous enteral feeding because of its low complication and mortality rates.
Percutaneous endoscopic gastrostomy (PEG) - An useful 'surgical' measure
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2006
Eight patients were studied to evaluate the efficacy of a surgeonled percutaneous endoscopic gastrostomy (PEG). Three patients underwent PEG at the time of elective surgery (carcinoma larynx-2, carcinoma tonsil-1), two underwent placements during emergency surgery for neck trauma (blunt injury-1, penetrating injury-1) and three for palliation (recurrent tongue carcinoma-1, recurrent epilaryngeal carcinoma-1, metastatic neck nodes-1). For patients undergoing intraoperative PEG, the operative time was prolonged by an average of 12 minutes. There were no major procedural or feedingrelated complications in any of the patients. Individual subjective tolerability was good in all patients. A surgeonled PEG is a simple and safe means of combining all the advantages of enteral nutrition with none of the disadvantages of nasogastric tube feeding in emergency, elective head and neck operations and in palliation. The procedure merits wider use in head and neck surgery units in India.
Gastrointestinal Endoscopy, 1999
Background: Percutaneous endoscopic gastrostomy (PEG) is a generally accepted procedure, but the appropriateness of patient selection and the justification of jejunal feeding have not been systematically investigated. Also, a critical appraisal of the applicability and tolerance of nutritional support in the immediate postinsertion period and during prolonged outpatient care is lacking. Methods: Prospectively collected data in adult and pediatric patients during a period of 7 years were analyzed. Follow-up data were available at days 1, 7 and 28 and thereafter every 6 to 12 weeks until gastrostomy removal, death or the conclusion of the study. Results: A PEG was successfully positioned in 268 of the 286 referred patients (94%). A jejunal tube through the PEG (JETPEG) was placed beyond the duodenojejunal ligament in 38 patients. Procedure-related mortality was 1%, 30-day outpatient mortality 6.7%. Total follow-up was 295 patient-years with an overall mortality of 53% (PEG 53%; JETPEG 50%). Both major (8.4%) and minor (24.0%) procedure-related complications in the first 28 days consisted merely of (infectious) wound problems. In prolonged follow-up, the complications were more tube-related. The durability of the tube in surviving patients with a PEG or JETPEG in situ was a median of 495 days (range 162 to 1732 days). Tube dysfunction because of clogging, porosity and fracture occurred after a median of 347 days (range 9 to 1123 days). Nausea, vomiting, bloating and dumping interfered with feeding during the first week and during extended follow-up. Intrajejunal feeding was associated with dumping and diarrhea. In retrospect, the anticipated need of 4 weeks of enteral nutrition was not met in 9.0%. The extension of a PEG into a JETPEG was thought inappropriate in 23.7%. In the remainder, a 91% reduction in aspiration justified its use. The tube life span was equal to or greater than that of a PEG, despite tube dysfunction in 26.8%. Conclusions: Proper selection of patients for a PEG, i.e., those with an anticipated need of greater than 4 weeks of enteral nutrition, is a challenge. Notwithstanding an increased rate of tube dysfunction, well-selected patients may benefit from a JETPEG. Follow-up is mandatory because many patients might have become malnourished or underfed while on tube feeding, mainly because of GI intolerance.
Predicting outcomes and complications of percutaneous endoscopic gastrostomy
Endoscopy, 2007
Introduction ! Obtaining enteral access has become the founda− tion of aggressive nutritional support. Since it was first described in 1980, percutaneous endo− scopic gastrostomy (PEG) has been the preferred route for long−term enteral feeding of patients whose gastrointestinal tract is functionally intact but who are unable to maintain sufficient oral in− take as a result of a variety of medical conditions [1 ± 3]. The most common indication is inade− quate swallowing because of a neurological event or secondary to oropharyngeal cancer. We can also use PEG for gastric decompression or nutri− tional supplementation in patients who are un− dergoing radiotherapy or chemotherapy. A num− ber of advantages have been claimed for PEG in comparison with nasogastric or orogastric tubes, such as greater comfort, less frequent displace− ment, greater improvement in nutritional status, and a better cosmetic appearance . Feeding via PEG should be the preferred method if the pa− tient's nutritional intake is likely to be inade− quate for a period exceeding 2 ± 4 weeks [1, 3]. PEG placement is considered to be an easy proce− dure, with a success rate of more than 95 % [4]. However, there have been very few prospective studies evaluating the outcomes of PEG [5 ± 8]. Kobayashi et al.
Percutaneous Endoscopic Gastrostomy: Technical Problems, Complications, and Management
Indian Journal of Surgery, 2015
Percutaneous endoscopic gastrostomy (PEG) is an important technique for the provision of nutrition. The present study presents data from our analysis of the PEG procedure. Patients administered with PEG at the endoscopy unit of the 19 Mayıs University General Surgery Department between 2007 and 2013 were analyzed retrospectively, and technical problems, indications, and complications related to the PEG procedure in 221 patients were evaluated. Of the patients, 60 % were male and the median age was 61 years (18-92 years). The most frequent indication was admittance to the intensive care unit, accounting for 46 % of the total, followed by neurological disease, with 41 %. The success rate of the procedure was 98 %, and the overall rate of complications was 22 %. No mortalities were reported as resulting from the procedure. The most common complication was the development of granulomas around the tube (8 %). PEG is a safe method of longterm feeding but is associated with a high rate of morbidity that can be treated easily using conservative treatment methods.