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Outcomes of PEG placement by acute care surgeons compared to those placed by gastroenterology

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Abstract

Background

Percutaneous endoscopic gastrostomy (PEG) tubes are placed by gastroenterologists (GI) and surgeons throughout the country. At Rhode Island Hospital, before July of 2017, all PEGs were placed by GI. In July of 2017, in response to a growing need for PEGs, acute care surgeons (ACS) also began performing PEGs at the bedside in ICUs. The purpose of this study was to review and compare outcomes of PEG tubes placed by ACS and GI.

Methods

Retrospective chart review of patients who received a PEG placed by ACS or GI at the bedside in any ICU from December 2016 to September 2019. Charts were reviewed for the following outcomes: Success rates of placing PEG, duration of procedure, major complications, and death. Secondary outcomes included discharge disposition, and rates of comfort measures only after PEG.

Results

In 2017, 75% of PEGs were placed by GI and 25% surgery. In 2018, 47% were placed by GI and 53% by surgery. In 2019, 33% were placed by GI and 67% by surgery. There was no significant difference in success rates between surgery (146/156 93.6%) and GI (173/185 93.5%) (p 0.97). On average, GI performed the procedure faster than surgery [Median 10 (7–16) min vs 16 (13–21) mins, respectively, p < 0.001]. There were no significant differences between groups in any of the PEG outcomes or complications investigated.

Conclusion

Bedside PEG tube placement appears to be a safe procedure in the ICU population. GI and Surgery had nearly identical success rates in placing PEGs. GI performed the procedure faster than surgery. There were no significant differences in the reviewed patient outcomes or complications between PEGs placed by ACS or GI. Of note, when a complication occurred, ACS PEG patients typically were managed in the OR while GI tended to re-PEG patients highlighting a potential difference in management that should be further investigated.

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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(6):872–875. https://doi.org/10.1016/s0022-3468(80)80296-x

    Article  CAS  PubMed  Google Scholar 

  2. Hucl T, Spicak J (2016) Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol 30(5):769–781. https://doi.org/10.1016/j.bpg.2016.10.002

    Article  PubMed  Google Scholar 

  3. Lynch CR, Fang JC (2004) Prevention and management of complications of percutaneous endoscopic gastrostomy (PEG) tubes. Pract Gastroenterol 28:66–77

    Google Scholar 

  4. Pih GY, Na HK, Ahn JY et al (2018) Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion. BMC Gastroenterol 18(1):101. https://doi.org/10.1186/s12876-018-0825-8

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schrag SP, Sharma R, Jaik NP et al (2007) Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointest Liver Dis 16(4):407

    Google Scholar 

  6. Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P (2012) Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol 47(6):737–742. https://doi.org/10.3109/00365521.2012.654404

    Article  PubMed  Google Scholar 

  7. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT (2014) Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 20(24):7739–7751. https://doi.org/10.3748/wjg.v20.i24.7739

    Article  PubMed  PubMed Central  Google Scholar 

  8. Day LW, Nazareth M, Sewell JL, Williams JL, Lieberman DA (2015) Practice variation in PEG tube placement: trends and predictors among providers in the United States. Gastrointest Endosc 82(1):37–45. https://doi.org/10.1016/j.gie.2014.12.049

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yarmus L, Gilbert C, Lechtzin N, Imad M, Ernst A, Feller-Kopman D (2013) Safety and feasibility of interventional pulmonologists performing bedside percutaneous endoscopic gastrostomy tube placement. Chest 144(2):436–440. https://doi.org/10.1378/chest.12-2550

    Article  PubMed  Google Scholar 

  10. Davis SS Jr, Husain FA, Lin E, Nandipati KC, Perez S, Sweeney JF (2013) Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes. J Am Coll Surg 216(1):96–104. https://doi.org/10.1016/j.jamcollsurg.2012.08.014

    Article  PubMed  Google Scholar 

  11. Papandria D, Rhee D, Ortega G et al (2012) Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP. J Surg Educ 69(2):149–155. https://doi.org/10.1016/j.jsurg.2011.08.003

    Article  PubMed  Google Scholar 

  12. Hernandez-Irizarry R, Zendejas B, Ali SM, Lohse CM, Farley DR (2012) Impact of resident participation on laparoscopic inguinal hernia repairs: are residents slowing us down? J Surg Educ 69(6):746–752. https://doi.org/10.1016/j.jsurg.2012.08.013

    Article  PubMed  Google Scholar 

  13. Jackson TD, Wannares JJ, Lancaster RT, Rattner DW, Hutter MM (2011) Does speed matter? The impact of operative time on outcome in laparoscopic surgery. Surg Endosc 25(7):2288–2295. https://doi.org/10.1007/s00464-010-1550-8

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ahmad J, Thomson S, McFall B, Scoffield J, Taylor M (2010) Colonic injury following percutaneous endoscopic-guided gastrostomy insertion. BMJ Case Rep. https://doi.org/10.1136/bcr.05.2010.2976

    Article  PubMed  PubMed Central  Google Scholar 

  15. Shaw J, Casey K (2009) A PEG tube through the liver. Am J Gastroenterol 104(5):1323–1324. https://doi.org/10.1038/ajg.2009.61

    Article  PubMed  Google Scholar 

  16. Chaer RA, Rekkas D, Trevino J, Brown R, Espat J (2003) Intrahepatic placement of a PEG tube. Gastrointest Endosc 57(6):763–765. https://doi.org/10.1067/mge.2003.201

    Article  PubMed  Google Scholar 

  17. (2017) ABS flexible endoscopy curriculum for general surgery residents. American Board of Surgery

  18. Voiosu T, Boskoski I, Voiosu AM et al (2020) Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter observational trial. Endoscopy 52(2):115–122. https://doi.org/10.1055/a-1049-0359

    Article  PubMed  Google Scholar 

  19. Abuksis G, Mor M, Segal N et al (2000) Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients. Am J Gastroenterol 95(1):128–132. https://doi.org/10.1111/j.1572-0241.2000.01672.x

    Article  CAS  PubMed  Google Scholar 

  20. Paillaud E, Bories PN, Merlier I, Richardet JP, Jeanfaivre V, Campillo B (2002) [Prognosis factors of short and long-term survival in elderly hospitalized patients after percutaneous endoscopic gastrostomy]. Facteurs pronostiques de la survie a court et long terme apres pose d'une gastrostomie percutanee endoscopique chez des malades ages hospitalises. Gastroenterol Clin Biol 26(5):443–447

  21. Lang A, Bardan E, Chowers Y et al (2004) Risk factors for mortality in patients undergoing percutaneous endoscopic gastrostomy. Endoscopy 36(6):522–526. https://doi.org/10.1055/s-2004-814400

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA

    Andrew Varone, Andrew Stephen, Tareq Kheirbek, Charles Adams & William Cioffi

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  1. Andrew Varone
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  2. Andrew Stephen
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  3. Tareq Kheirbek
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  4. Charles Adams
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Correspondence to Andrew Varone.

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Drs. Andrew Varone, Charles Adams, William Cioffi, Tareq Kheirbek, and Andrew Stephen have no conflict of interest or financial ties to disclose.

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Appendix

Appendix

The Pull technique for PEG placement, a brief overview

Pre-operative antibiotics (ancef) are given. The patient is placed supine and the procedure involves first performing an upper endoscopy, insufflating the stomach, and looking at the anterior abdominal wall. Then, using manual deflection with a finger typically in the left upper quadrant, several fingerbreadths below the coastal margin, the abdominal wall is deflected in toward the stomach looking for (1) trans-illumination of the abdominal wall from the light on the end of the endoscope and (2) excellent deflection of the stomach wall to suggest that the wall of the insufflated stomach is up against the anterior abdominal wall without other organs (colon, liver, etc.) between the target. At this point, local anesthesia is injected at the potential site. A needle on a syringe is advanced through the abdominal wall into the stomach under direct endoscopic visualization while at the same time aspirating the syringe. This aspiration technique is done to ensure no aspiration of air, blood, or stool is encountered which would suggest potential injury to an adjacent organ. The needle is removed leaving the sheath in place. A guidewire is inserted into the stomach through the sheath and grasped with the endoscopic snare. The scope and wire are brought out through the mouth and the gastrostomy tube is secured to the guidewire. The guidewire is then pulled through the abdominal wall therefore bringing the wire and PEG into the stomach. It is secured externally with the bumper. The endoscope is re-inserted into the stomach to ensure appropriate positioning, a freely spinning internal bumper, and to decompress the stomach.

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Varone, A., Stephen, A., Kheirbek, T. et al. Outcomes of PEG placement by acute care surgeons compared to those placed by gastroenterology. Surg Endosc 36, 8214–8220 (2022). https://doi.org/10.1007/s00464-022-09262-2

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  • DOI: https://doi.org/10.1007/s00464-022-09262-2

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