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Published in: Surgical Endoscopy 8/2006

01-08-2006

Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial

Authors: M. Ljungdahl, M. Sundbom

Published in: Surgical Endoscopy | Issue 8/2006

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Abstract

Background

Percutaneous endoscopic gastrostomy (PEG) has increasingly replaced surgical gastrostomy (SG) as the primary procedure for the long-term nutrition of patients with swallowing disorders. This prospective randomized study compares PEG with SG in terms of effectiveness and safety.

Methods

This study enrolled 70 patients with swallowing disorders, mainly attributable to neurologic impairment. All the patients, eligible for both techniques, were randomized to PEG (pull method) or SG. The groups were comparable in terms of age, body mass index, and underlying diseases. Complications were reported 7 and 30 days after the operative procedure.

Results

The procedures were successfully completed for all the patients. The median operative time was 15 min for PEG and 35 min for SG (p < 0.001). The rate of complications was lower for PEG (42.9%) than for SG (74.3%; p < 0.01). The 30-day mortality rates were 5.7% for PEG and 14.3% for SG (nonsignificant difference).

Conclusion

The findings show PEG to be an efficient method for gastrostomy tube placement with a lower complication rate than SG. In addition, PEG is faster to perform and requires fewer medical resources. The authors consider PEG to be the primary procedure for gastrostomy tube placement.
Literature
1.
go back to reference Akkerdijk WL, van Bergeijk JD, van Egmond T, Mulder CJJ, van Berge Henegouwen van der Werken C, van Erpecum KJ (1995) Percutaneous endoscopic gastrostomy (PEG): comparison of push and pull methods and evaluation of antibiotic prophylaxis. Endoscopy 27: 313–316 Akkerdijk WL, van Bergeijk JD, van Egmond T, Mulder CJJ, van Berge Henegouwen van der Werken C, van Erpecum KJ (1995) Percutaneous endoscopic gastrostomy (PEG): comparison of push and pull methods and evaluation of antibiotic prophylaxis. Endoscopy 27: 313–316
2.
go back to reference Bergstrom LR, Larson DE, Zinsmeister AR, Sarr MG, Silverstein MD (1995) Utilisation and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: a population-based study. Mayo Clin Proc 70: 829–836PubMedCrossRef Bergstrom LR, Larson DE, Zinsmeister AR, Sarr MG, Silverstein MD (1995) Utilisation and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: a population-based study. Mayo Clin Proc 70: 829–836PubMedCrossRef
3.
go back to reference Callahan CM, Haag KM, Weinberger M, Tierney WM, Buchanan NN, Stump TE, Nisi R (2000) Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc 48: 1048–1054PubMed Callahan CM, Haag KM, Weinberger M, Tierney WM, Buchanan NN, Stump TE, Nisi R (2000) Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc 48: 1048–1054PubMed
4.
go back to reference Cosentini EP, Sautner T, Gnant M, Winkelbauer F, Teleky B, Jakesz R (1998) Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies. Arch Surg 133: 1076–1088PubMedCrossRef Cosentini EP, Sautner T, Gnant M, Winkelbauer F, Teleky B, Jakesz R (1998) Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies. Arch Surg 133: 1076–1088PubMedCrossRef
5.
go back to reference Dormann AJ, Wigginghaus B, Risius H, Kleimann F, Kloppenborg A, Grunewald T, Huchzermeyer H (1999) A single dose of ceftriaxone administered 30 minutes before percutaneous endoscopic gastrostomy significantly reduces local and systemic infective complications. Am J Gastroenterol 94: 3220–3224PubMedCrossRef Dormann AJ, Wigginghaus B, Risius H, Kleimann F, Kloppenborg A, Grunewald T, Huchzermeyer H (1999) A single dose of ceftriaxone administered 30 minutes before percutaneous endoscopic gastrostomy significantly reduces local and systemic infective complications. Am J Gastroenterol 94: 3220–3224PubMedCrossRef
6.
go back to reference Ehrsson YT, Langius-Eklof A, Bark T, Laurell G (2004) Percutaneous endoscopic gastrostomy (PEG): a long-term follow-up study in head and neck cancer patients. Clin Otolaryngol 29: 740–746PubMedCrossRef Ehrsson YT, Langius-Eklof A, Bark T, Laurell G (2004) Percutaneous endoscopic gastrostomy (PEG): a long-term follow-up study in head and neck cancer patients. Clin Otolaryngol 29: 740–746PubMedCrossRef
7.
go back to reference Gauderer MWL, Ponsky JL, Izant RJ Jr (1980) Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15: 872–875PubMed Gauderer MWL, Ponsky JL, Izant RJ Jr (1980) Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15: 872–875PubMed
8.
go back to reference Gencosmanoglu R, Koc D, Tozun N (2003) Percutaneous endoscopic gastrostomy: results of 115 cases. Hepatogastroenterology 50: 886–888PubMed Gencosmanoglu R, Koc D, Tozun N (2003) Percutaneous endoscopic gastrostomy: results of 115 cases. Hepatogastroenterology 50: 886–888PubMed
9.
go back to reference Grant JP (1998) Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg 207: 598–603CrossRef Grant JP (1998) Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg 207: 598–603CrossRef
10.
go back to reference Ho HS, Ngo H (1999) Gastrostomy for enteral access: a comparison among placement by laparotomy, laparoscopy, and endoscopy. Surg Endosc 13: 991–994PubMedCrossRef Ho HS, Ngo H (1999) Gastrostomy for enteral access: a comparison among placement by laparotomy, laparoscopy, and endoscopy. Surg Endosc 13: 991–994PubMedCrossRef
11.
go back to reference Jones M, Santanello SA, Falcone RE (1990) Percutaneous endoscopic vs surgical gastrostomy. JPEN J Parenter Enteral Nutr 14: 533–534PubMedCrossRef Jones M, Santanello SA, Falcone RE (1990) Percutaneous endoscopic vs surgical gastrostomy. JPEN J Parenter Enteral Nutr 14: 533–534PubMedCrossRef
12.
go back to reference Klose J, Heldwein W, Rafferzeder M, Sernetz F, Gross M, Loeschke K (2003) Nutritional status and quality of life in patients with percutaneous endoscopic gastrostomy (PEG) in practice: prospective one-year follow-up. Dig Dis Sci 48: 2057–2063PubMedCrossRef Klose J, Heldwein W, Rafferzeder M, Sernetz F, Gross M, Loeschke K (2003) Nutritional status and quality of life in patients with percutaneous endoscopic gastrostomy (PEG) in practice: prospective one-year follow-up. Dig Dis Sci 48: 2057–2063PubMedCrossRef
13.
go back to reference Larson DE, Burton DD, Schroeder KW, DiMagno EP (1987) Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 93: 48–52PubMed Larson DE, Burton DD, Schroeder KW, DiMagno EP (1987) Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 93: 48–52PubMed
14.
go back to reference Mamel JJ (1989) Percutaneous endoscopic gastrostomy. Am J Gastroenterol 84: 703–710PubMed Mamel JJ (1989) Percutaneous endoscopic gastrostomy. Am J Gastroenterol 84: 703–710PubMed
15.
go back to reference Miller RE, Castlemain B, Lacqua FJ, Kotler DP (1989) Percutaneous endoscopic gastrostomy: results in 316 patients and review of literature. Surg Endosc 3: 186–190PubMedCrossRef Miller RE, Castlemain B, Lacqua FJ, Kotler DP (1989) Percutaneous endoscopic gastrostomy: results in 316 patients and review of literature. Surg Endosc 3: 186–190PubMedCrossRef
16.
go back to reference Miller RE, Kummer BA, Tiszenkel HI, Kotler DP (1986) Percutaneous endoscopic gastrostomy: procedure of choice. Ann Surg 204: 543–545PubMed Miller RE, Kummer BA, Tiszenkel HI, Kotler DP (1986) Percutaneous endoscopic gastrostomy: procedure of choice. Ann Surg 204: 543–545PubMed
17.
go back to reference Moller P, Lindberg CG, Zilling T (1999) Gastrostomy by various techniques: evaluation of indications, outcome, and complications. Scand J Gastroenterol 34: 1050–1054PubMedCrossRef Moller P, Lindberg CG, Zilling T (1999) Gastrostomy by various techniques: evaluation of indications, outcome, and complications. Scand J Gastroenterol 34: 1050–1054PubMedCrossRef
18.
go back to reference Morgenstern L, Laquer M, Treyzon L (2005) Ethical challenges of percutaneous endoscopic gastrostomy. Surg Endosc 19: 398–400PubMedCrossRef Morgenstern L, Laquer M, Treyzon L (2005) Ethical challenges of percutaneous endoscopic gastrostomy. Surg Endosc 19: 398–400PubMedCrossRef
19.
go back to reference Oyogoa S, Schein M, Gardezi S, Wise L (1999) Surgical feeding gastrostomy: are we overdoing it? J Gastrointest Surg 3: 152–155PubMedCrossRef Oyogoa S, Schein M, Gardezi S, Wise L (1999) Surgical feeding gastrostomy: are we overdoing it? J Gastrointest Surg 3: 152–155PubMedCrossRef
20.
go back to reference Petersen TI, Kruse A (1997) Complications of percutaneous endoscopic gastrostomy. Eur J Surg 163: 351–356PubMed Petersen TI, Kruse A (1997) Complications of percutaneous endoscopic gastrostomy. Eur J Surg 163: 351–356PubMed
21.
go back to reference Ponsky JL, Gauderer MWL, Stellato TA (1983) Percutaneous endoscopic gastrostomy: review of 150 cases. Arch Surg 118: 913–914PubMed Ponsky JL, Gauderer MWL, Stellato TA (1983) Percutaneous endoscopic gastrostomy: review of 150 cases. Arch Surg 118: 913–914PubMed
22.
go back to reference Rabaneck L, McCullough LB, Wray NP (1997) Ethically justified, clinically comprehensive guidelines for percutaneous endoscopic gastrostomy tube placement. Lancet 349: 496–498CrossRef Rabaneck L, McCullough LB, Wray NP (1997) Ethically justified, clinically comprehensive guidelines for percutaneous endoscopic gastrostomy tube placement. Lancet 349: 496–498CrossRef
23.
go back to reference Sanders DS, Carter MJ, D’Silva J, James G, Bolton RB, Bardhan KD (2000) Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol 95: 1472–1475PubMedCrossRef Sanders DS, Carter MJ, D’Silva J, James G, Bolton RB, Bardhan KD (2000) Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol 95: 1472–1475PubMedCrossRef
24.
go back to reference Sanders DS, Carter MJ, D’Silva J, McAlindon ME, Willemse PJ, Bardham KD (2001) Percutaneous endoscopic gastrostomy: a prospective analysis of hospital support required and complications following discharge to the community. Eur J Clin Nutr 55: 610–614PubMedCrossRef Sanders DS, Carter MJ, D’Silva J, McAlindon ME, Willemse PJ, Bardham KD (2001) Percutaneous endoscopic gastrostomy: a prospective analysis of hospital support required and complications following discharge to the community. Eur J Clin Nutr 55: 610–614PubMedCrossRef
25.
go back to reference Scott JS, de la Torre RA, Unger SW (1991) Comparison of operative versus percutaneous endoscopic gastrostomy tube placement in the elderly. Am Surg 57: 338–340PubMed Scott JS, de la Torre RA, Unger SW (1991) Comparison of operative versus percutaneous endoscopic gastrostomy tube placement in the elderly. Am Surg 57: 338–340PubMed
26.
go back to reference Sheehan JJ, Hill AD, Fanning NP, Healy C, McDermott EW, O’Donoghue DP, O’Higgins (2003) Percutaneous endoscopic gastrostomy: 5 years of clinical experience on 238 patients. Ir Med J 96: 265–267PubMed Sheehan JJ, Hill AD, Fanning NP, Healy C, McDermott EW, O’Donoghue DP, O’Higgins (2003) Percutaneous endoscopic gastrostomy: 5 years of clinical experience on 238 patients. Ir Med J 96: 265–267PubMed
27.
go back to reference Skelly RH, Kupfer RM, Metcalfe ME, Allison SP, Holt M, Hull MA, Rawlings JK (2002) Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988. Clin Nutr 21: 389–394PubMedCrossRef Skelly RH, Kupfer RM, Metcalfe ME, Allison SP, Holt M, Hull MA, Rawlings JK (2002) Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988. Clin Nutr 21: 389–394PubMedCrossRef
28.
go back to reference Stiegmann GV, Goff JS, Silas D, Pearlman N, Sun J, Norton L (1990) Endoscopic versus operative gastrostomy: final results of a prospective randomised trial. Gastrointest Endosc 36: 1–5PubMedCrossRef Stiegmann GV, Goff JS, Silas D, Pearlman N, Sun J, Norton L (1990) Endoscopic versus operative gastrostomy: final results of a prospective randomised trial. Gastrointest Endosc 36: 1–5PubMedCrossRef
29.
go back to reference Stuart SP, Tiley EH, Boland JP (1993) Feeding gastrostomy: a critical review of its indications and mortality rate. South Med J 86: 169–172PubMed Stuart SP, Tiley EH, Boland JP (1993) Feeding gastrostomy: a critical review of its indications and mortality rate. South Med J 86: 169–172PubMed
30.
go back to reference Wilkinson WA, Pickleman J (1982) Feeding gastrostomy: a reappraisal. Am Surg 48: 273–275PubMed Wilkinson WA, Pickleman J (1982) Feeding gastrostomy: a reappraisal. Am Surg 48: 273–275PubMed
31.
go back to reference Wollman B, D’Agostino HB, Walus-Wigle JR, Easter DW, Beale A (1995) Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology 197: 699–704PubMed Wollman B, D’Agostino HB, Walus-Wigle JR, Easter DW, Beale A (1995) Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology 197: 699–704PubMed
Metadata
Title
Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial
Authors
M. Ljungdahl
M. Sundbom
Publication date
01-08-2006
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 8/2006
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-005-0757-6

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