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Percutaneous endoscopic gastrostomy (PEG) with T-fasteners obviates the need for emergent replacement after early tube dislodgement

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Abstract

Background

Despite technical refinements of percutaneous endoscopic gastrostomy (PEG) tube placement, complications such as early tube dislodgement remain relatively static. This study aimed to review the experience of a high-volume endoscopy center after the introduction of T-fastener placement in high-risk patients.

Methods

The authors retrospectively reviewed PEG placement from October 2010 to September 2011, when their group began to use T-fasteners selectively in high-risk patients. Patients deemed to have an increased risk for early tube dislodgement underwent T-fastener placement at the time of PEG placement. Patients with PEG alone were compared with patients who had PEG with T-fastener (PEG-T) placement. Statistical analysis was performed using SPSS version 18.

Results

During the study period, 195 patients underwent PEG placement. For 121 patients, PEG alone was performed, whereas PEG-T was performed for 74 patients. Six patients had tube dislodgement (five early, one late) in the PEG-T cohort versus none in the PEG-alone cohort (P = 0.003). The first patient underwent diagnostic laparoscopy with replacement gastrostomy 2 days after tube dislodgement and was noted to have no contamination, with direct apposition of the stomach to the abdominal wall from the T-fasteners. The subsequent four patients with early tube dislodgement underwent non-emergent PEG replacement in the endoscopy unit within 24 h after tube dislodgement. In the short-term follow-up period, no repeat dislodgements were noted. Early mortality in the entire cohort was experienced by 38 (19.5 %) of the 195 patients.

Conclusion

Placement of T-fasteners in high-risk patients may decrease overall morbidity if early tube dislodgement occurs. The findings show the safety of non-emergent endoscopic replacement of PEGs in certain patients. Early tube dislodgement may be a marker of overall mortality.

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References

  1. Gauderer MW, Ponsky JL, Izant RJ Jr (1980) Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15:872–875

    Article  PubMed  CAS  Google Scholar 

  2. Felsher J, Chand B, Ponsky J (2004) Decompressive percutaneous endoscopic gastrostomy in nonmalignant disease. Am J Surg 187:254–256

    Article  PubMed  Google Scholar 

  3. Gauderer MW (2001) Percutaneous endoscopic gastrostomy–20 years later: a historical perspective. J Pediatr Surg 36:217–219

    Article  PubMed  CAS  Google Scholar 

  4. Deitel M, Bendago M, Spratt EH, Burul CJ, To TB (1988) Percutaneous endoscopic gastrostomy by the “pull” and “introducer” methods. Can J Surg 31:102–104

    PubMed  CAS  Google Scholar 

  5. Saini S, Mueller PR, Gaa J, Briggs SE, Hahn PF, Forman BH, Tung GA, Silverman SG, Lee MJ, Morrison MC, Brown AT, Ferrucci JT (1990) Percutaneous gastrostomy with gastropexy: experience in 125 patients. AJR Am J Roentgenol 154:1003–1006

    PubMed  CAS  Google Scholar 

  6. Nishiwaki S, Araki H, Fang JC, Hayashi M, Takada J, Iwashita M, Tagami A, Hatakeyama H, Hayashi T, Maeda T, Saito K (2011) Retrospective analyses of complications associated with transcutaneous replacement of percutaneous gastrostomy and jejunostomy feeding devices. Gastrointest Endosc 74:784–791

    Article  PubMed  Google Scholar 

  7. Villalona GA, McKee MA, Diefenbach KA (2011) Modified laparoscopic gastrostomy technique reduces gastrostomy tract dehiscence. J Laparoendosc Adv Surg Tech 21:355–359

    Article  Google Scholar 

  8. Shellito PC, Malt RA (1985) Tube gastrostomy: techniques and complications. Ann Surg 201:180–185

    Article  PubMed  CAS  Google Scholar 

  9. Amann W, Mischinger HJ, Berger A, Rosanelli G, Schweiger W, Werkgartner G, Fruhwirth J, Hauser H (1997) Percutaneous endoscopic gastrostomy (PEG): 8 years of clinical experience in 232 patients. Surg Endosc 11:741–744

    Article  PubMed  CAS  Google Scholar 

  10. Schulenberg E, Schule S, Lehnert T (2010) Emergency surgery for complications related to percutaneous endoscopic gastrostomy. Endoscopy 42:872–874

    Article  PubMed  CAS  Google Scholar 

  11. Schurink CA, Tuynman H, Scholten P, Arjaans W, Klinkenberg-Knol EC, Meuwissen SG, Kuipers EJ (2001) Percutaneous endoscopic gastrostomy: complications and suggestions to avoid them. Eur J Gastroenterol Hepatol 13:819–823

    Article  PubMed  CAS  Google Scholar 

  12. Marshall JB, Bodnarchuk G, Barthel JS (1994) Early accidental dislodgement of PEG tubes. J Clin Gastroenterol 18:210–212

    Article  PubMed  CAS  Google Scholar 

  13. Terry NE, Boswell WC, Carney DE, Beck A, Lowe L, Rittmeyer C (2008) Percutaneous endoscopic gastrostomy with T-bar fixation in children and infants. Surg Endosc 22:167–170

    Article  PubMed  CAS  Google Scholar 

  14. Wills JS, Oglesby JT (1983) Percutaneous gastrostomy. Radiology 149:449–453

    PubMed  CAS  Google Scholar 

  15. Wollman B, D’ Agostino HB (1997) Percutaneous radiologic and endoscopic gastrostomy: a 3-year institutional analysis of procedure performance. AJR Am J Roentgenol 169:1551–1553

    PubMed  CAS  Google Scholar 

  16. Dinkel HP, Beer KT, Zbaren P, Triller J (2002) Establishing radiological percutaneous gastrostomy with balloon-retained tubes as an alternative to endoscopic and surgical gastrostomy in patients with tumours of the head and neck or oesophagus. Br J Radiol 75:371–377

    PubMed  Google Scholar 

  17. Perona F, Castellazzi G, De Iuliis A, Rizzo L (2010) Percutaneous radiologic gastrostomy: a 12-year series. Gut Liver 4(Suppl 1):S44–S49

    Article  PubMed  Google Scholar 

  18. Korula J, Harma C (1991) A simple and inexpensive method of removal or replacement of gastrostomy tubes. JAMA 265:1426–1428

    Article  PubMed  CAS  Google Scholar 

  19. Pearce CB, Goggin PM, Collett J, Smith L, Duncan HD (2000) The “cut and push” method of percutaneous endoscopic gastrostomy tube removal. Clin Nutr 19:133–135

    Article  PubMed  CAS  Google Scholar 

  20. Cass OW, Rowland K, Bartram B, Ross JR, Choe Y, Hall JD (1999) Insertion, efficacy, and removal of a nonendoscopically removable percutaneous endoscopic gastrostomy (PEG) tube. Surg Endosc 13:516–519

    Article  PubMed  CAS  Google Scholar 

  21. Hashiba K, Fabbri CE, Cappellanes CA, Branco PD, Birolini D, Oliveira MR (1984) Endoscopic percutaneous gastrostomy without laparotomy. Endoscopy 16:219–222

    Article  PubMed  CAS  Google Scholar 

  22. Mellinger JD, Simon IB, Schlechter B, Lash RH, Ponsky JL (1991) Tract formation following percutaneous endoscopic gastrostomy in an animal model. Surg Endosc 5:189–191

    Article  PubMed  CAS  Google Scholar 

  23. Galaski A, Peng WW, Ellis M, Darling P, Common A, Tucker E (2009) Gastrostomy tube placement by radiological versus endoscopic methods in an acute care setting: a retrospective review of frequency, indications, complications, and outcomes. Can J Gastroenterol 23:109–114

    PubMed  Google Scholar 

  24. Gutt CN, Held S, Paolucci V, Encke A (1996) Experiences with percutaneous endoscopic gastrostomy. World J Surg 20:1006–1008

    Article  PubMed  CAS  Google Scholar 

  25. MacLean AA, Alvarez NR, Davies JD, Lopez PP, Pizano LR (2007) Complications of percutaneous endoscopic and fluoroscopic gastrostomy tube insertion procedures in 378 patients. Gastroenterol Nurs 30:337–341

    Article  PubMed  Google Scholar 

  26. Pofahl WE, Ringold F (1999) Management of early dislodgment of percutaneous endoscopic gastrostomy tubes. Surg Laparosc Endosc Percutan Tech 9:253–256

    Article  PubMed  CAS  Google Scholar 

  27. Brown AS, Mueller PR, Ferrucci JT Jr (1986) Controlled percutaneous gastrostomy: nylon T-fastener for fixation of the anterior gastric wall. Radiology 158:543–545

    PubMed  CAS  Google Scholar 

  28. Foster A, Given M, Thornton E, Geoghegan T, Keeling F, McGrath F, Lee MJ (2009) Removal of T-fasteners 2 days after gastrostomy is feasible. Cardiovasc Intervent Radiol 32:317–319

    Article  PubMed  CAS  Google Scholar 

  29. Collure DW, Bumpers HL, Hoover EL (1996) A complication of T-fasteners in percutaneous endoscopic gastrostomy (PEG) placement. Surg Endosc 10:938–939

    Article  PubMed  CAS  Google Scholar 

  30. Ho T, Margulies D (1999) Pneumoperitoneum from an eroded T-fastener. Surg Endosc 13:285–286

    Article  PubMed  CAS  Google Scholar 

  31. Foutch PG, Talbert GA, Waring JP, Sanowski RA (1988) Percutaneous endoscopic gastrostomy in patients with prior abdominal surgery: virtues of the safe tract. Am J Gastroenterol 83:147–150

    PubMed  CAS  Google Scholar 

  32. Rosenberger LH, Newhook T, Schirmer B, Sawyer RG (2011) Late accidental dislodgement of a percutaneous endoscopic gastrostomy tube: an underestimated burden on patients and the health care system. Surg Endosc 25:3307–3311

    Article  PubMed  Google Scholar 

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Disclosures

M. Kroh has served as a consultant for Intuitive, Bard, Ethicon, and Covidien, receiving honoraria from these firms. Bipan Chand has served as a consultant for Bard, Covidien, Ethicon, and Sanofi-Aventis and has received honoraria from these firms. P. Timratana, K. El-Hayek, and H. Shimizu have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    P. Timratana, K. El-Hayek, H. Shimizu & M. Kroh

  2. Division of GI/Minimally Invasive Surgery, Loyola University Medical Center , Stritch School of Medicine, 2160 South First Avenue, Bldg. 110-Room 3291, Maywood, IL, 60153, USA

    B. Chand

Authors
  1. P. Timratana
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  2. K. El-Hayek
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  3. H. Shimizu
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  4. M. Kroh
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  5. B. Chand
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Correspondence to K. El-Hayek or B. Chand.

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Timratana, P., El-Hayek, K., Shimizu, H. et al. Percutaneous endoscopic gastrostomy (PEG) with T-fasteners obviates the need for emergent replacement after early tube dislodgement. Surg Endosc 26, 3541–3547 (2012). https://doi.org/10.1007/s00464-012-2348-7

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