Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO) (original) (raw)
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Short- and long-term outcomes from percutaneous endoscopic gastrostomy with jejunal extension
Surgical Endoscopy, 2016
Background-There is a paucity of data regarding the safety and efficacy of PEG-J. We evaluated adverse events related to percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) and determined the clinical impact of PEG-J in those with chronic pancreatitis (CP). Methods-This cohort study included all patients who underwent PEG-J placement in a tertiarycare academic medical center between 2010-2012. Main outcome measurements were 1) shortand long-term complications related to PEG-J; 2) changes in weight and hospitalizations during the 12-month period before and after PEG-J in the CP subgroup. Results-Of 102 patients undergoing PEG-J placement, the overall technical success rate was 97%. During a median follow-up period of 22 months (1-46 months, n=90), at least one tube malfunction occurred in 52/90 (58%; 177 episodes) after a median of 53 days (3-350 days), requiring a median of 2 tube replacements. Short-term (<30 days) tube malfunction occurred in 28/90 (31%) and delayed in 24/90 (27%); these included dislodgement (29%), clogging (26%) and kinking (14%). In the CP subgroup (n=58), mean body weight (kg) (70 vs. 71, p=0.06) and body mass index (kg/m 2 , 26 vs. 27, p=0.05) increased post-PEG-J. Mean number of hospitalizations (5 vs. 2, p<0.0001) and inpatient days per 12 months (22 vs. 12, p=0.005) decreased. Conclusions-While we observed no major complications related to PEG-J, half of patients had at least one episode of tube malfunction. In the CP subgroup, jejunal feeding via PEG-J significantly reduced the number of hospitalizations and inpatients days, while improving nutritional parameters.
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.
Decompressive percutaneous endoscopic gastrostomy in nonmalignant disease
The American Journal of Surgery, 2004
Background: Percutaneous endoscopic gastrostomy is the standard for long-term enteral access. It can provide enteral nutrition or gastrointestinal decompression. Utilization of the gastrostomy for decompression has traditionally been reported in the setting of malignant obstruction. However, decompressive gastrostomy can play a role in the treatment of nonmalignant bowel dysfunction as well. Methods: Over a 2-year period, 20 of 121 percutaneous endoscopic gastrostomies attempted by this surgical endoscopist were for gastrointestinal decompression. Results: Eleven of 18 gastrostomies successfully placed for decompression were for benign conditions. In 5 patients with fistulous disease, the purpose of decompression was to divert the gastrointestinal tract until operative repair. Four of these patients have since undergone definitive surgery. Conclusions: This series presents the successful use of the percutaneous endoscopic gastrostomy for decompression of nonmalignant conditions. In such scenarios, the drainage gastrostomy can be employed as a bridge to future surgery, or as a means of long-term decompression for bowel dysfunction.
Bertolini 2007 World J Gastroenterol
Percutaneous endoscopic colostomy (PEC) is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal p s e u d o -o b s t r u c t i o n e vo l v i n g s i n c e 8 ye a r s wa s readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient's quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications. B ertolini D, De Saussure P, Chilcott M, Girardin M, Dumonceau JM. Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: A case report and review of the literature. World J Gastroenterol 2007; 13(15): 2255-2257
Percutaneous Endoscopic Gastrostomy for Gastrointestinal Decompression
Annals of Surgery, 1987
, 185 percutaneous endoscopic gastrostomies were performed at University Hospitals of Cleveland. Of these, nine (5%) were done for chronic gastrointestinal decompression and form the basis of this report. Patients ranged in age from 21-73 years (mean: 51 years) and all had prolonged, complex hospitalizations extending 25-122 days
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.