Advertisement

Digestive Diseases and Sciences

, Volume 59, Issue 1, pp 117–125 | Cite as

Risk Factors for Complications of Percutaneous Endoscopic Gastrostomy

  • Sang Pyo Lee
  • Kang Nyeong LeeEmail author
  • Oh Young Lee
  • Hang Lak Lee
  • Dae Won Jun
  • Byung Chul Yoon
  • Ho Soon Choi
  • Seung Hyun Kim
Original Article

Abstract

Background

Percutaneous endoscopic gastrostomy (PEG) is a commonly performed procedure for patients with severe dysphagia leading to malnutrition. Improved knowledge of risk factors for PEG-related complications might decrease patient discomfort and healthcare costs.

Aim

The aim of the present study was to investigate factors associated with complications after PEG.

Methods

A retrospective review was performed for all patients referred for PEG placement from December 2002 to December 2012 in single-tertiary care center. PEG-related complications and risk factors were evaluated through chart reviews, endoscopic reports, and endoscopic and radiologic images.

Results

Among a total of 245 consecutive individuals (146 male, mean age 59.2 ± 12.6 years) enrolled, 43 major complications had developed. Multivariate analysis revealed that patients with an internal bolster of a PEG tube in the upper body of stomach were at significant risk for early [OR 6.127 (95 % CI 1.447–26.046)] and late complications [OR 6.710 (95 % CI 1.692–26.603)]. Abnormal leukocyte counts [OR 3.198 (95 % CI 1.174–8.716)], stroke as an indication for PEG [OR 3.047 (95 % CI 1.174–8.882)], and PEG tube placement by an inexperienced endoscopist [OR 3.401 (95 % CI 1.073–10.779)] were significantly associated with early complications.

Conclusions

A PEG tube should not be inserted into the upper body of stomach to reduce complication risk, and PEG procedures should be performed by skilled endoscopists to prevent early complications. An abnormal leukocyte count can be a predictor of early complication, and care is needed when PEG is performed for patients with stroke.

Keywords

Gastrostomy Percutaneous endoscopic gastrostomy Complications Therapeutic endoscopy 

Abbreviations

PEG

Percutaneous endoscopic gastrostomy

ALS

Amyotrophic lateral sclerosis

BMI

Body mass index

SLE

Systemic lupus erythematosis

CRP

C-reactive protein

ASA

American Society of Anesthesiology

Notes

Conflict of interest

None.

References

  1. 1.
    Kurien M, McAlindon ME, Westaby D, Sanders DS. Percutaneous endoscopic gastrostomy (PEG) feeding. BMJ. 2010;340:c2414.PubMedCrossRefGoogle Scholar
  2. 2.
    Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. 1980. Nutrition. 1998;14:736–738.PubMedCrossRefGoogle Scholar
  3. 3.
    Mendiratta P, Tilford JM, Prodhan P, Curseen K, Azhar G, Wei JY. Trends in percutaneous endoscopic gastrostomy placement in the elderly from 1993 to 2003. Am J Alzheimers Dis Other Demen. 2012;27:609–613.PubMedCrossRefGoogle Scholar
  4. 4.
    Wilhelm SM, Ortega KA, Stellato TA. Guidelines for identification and management of outpatient percutaneous endoscopic gastrostomy tube placement. Am J Surg. 2010;199:396–399. (discussion 399–400).PubMedCrossRefGoogle Scholar
  5. 5.
    Norton B, Homer-Ward M, Donnelly MT, Long RG, Holmes GK. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ. 1996;312:13–16.PubMedCrossRefGoogle Scholar
  6. 6.
    Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. 2005;365:764–772.PubMedCrossRefGoogle Scholar
  7. 7.
    Wiggenraad RG, Flierman L, Goossens A, et al. Prophylactic gastrostomy placement and early tube feeding may limit loss of weight during chemoradiotherapy for advanced head and neck cancer, a preliminary study. Clin Otolaryngol. 2007;32:384–390.PubMedCrossRefGoogle Scholar
  8. 8.
    Nugent B, Lewis S, O’Sullivan JM. Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy. Cochrane Database Syst Rev. 2010;CD007904.Google Scholar
  9. 9.
    Grant DG, Bradley PT, Pothier DD, et al. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol. 2009;34:103–112.PubMedCrossRefGoogle Scholar
  10. 10.
    Spataro R, Ficano L, Piccoli F, La Bella V. Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: effect on survival. J Neurol Sci. 2011;304:44–48.PubMedCrossRefGoogle Scholar
  11. 11.
    Zamietra K, Lehman EB, Felgoise SH, Walsh SM, Stephens HE, Simmons Z. Non-invasive ventilation and gastrostomy may not impact overall quality of life in patients with ALS. Amyotroph Lateral Scler. 2012;13:55–58.PubMedCrossRefGoogle Scholar
  12. 12.
    Beasley SW, Catto-Smith AG, Davidson PM. How to avoid complications during percutaneous endoscopic gastrostomy. J Pediatr Surg. 1995;30:671–673.PubMedCrossRefGoogle Scholar
  13. 13.
    Taylor CA, Larson DE, Ballard DJ, et al. Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study. Mayo Clin Proc. 1992;67:1042–1049.PubMedCrossRefGoogle Scholar
  14. 14.
    Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology. 1987;93:48–52.PubMedGoogle Scholar
  15. 15.
    Ermis F, Ozel M, Oncu K, et al. Indications, complications and long-term follow-up of patients undergoing percutaneous endoscopic gastrostomy: a retrospective study. Wien Klin Wochenschr. 2012;124:148–153.PubMedCrossRefGoogle Scholar
  16. 16.
    Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol. 2012;47:737–742.PubMedCrossRefGoogle Scholar
  17. 17.
    Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci. 2000;55:M735–M739.PubMedCrossRefGoogle Scholar
  18. 18.
    Blomberg J, Lagergren P, Martin L, Mattsson F, Lagergren J. Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy in a prospective cohort study. Gastrointest Endosc. 2011;73:29–36.PubMedCrossRefGoogle Scholar
  19. 19.
    Fox VL, Abel SD, Malas S, Duggan C, Leichtner AM. Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young adults. Gastrointest Endosc. 1997;45:64–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Fascetti-Leon F, Gamba P, Dall’Oglio L, et al. Complications of percutaneous endoscopic gastrostomy in children: results of an Italian multicenter observational study. Dig Liver Dis. 2012;44:655–659.PubMedCrossRefGoogle Scholar
  21. 21.
    Richards DM, Tanikella R, Arora G, Guha S, Dekovich AA. Percutaneous endoscopic gastrostomy in cancer patients: predictors of 30-day complications, 30-day mortality, and overall mortality. Dig Dis Sci. 2013;58:768–776. doi: 10.1007/s10620-012-2397-8.Google Scholar
  22. 22.
    Figueiredo FA, da Costa MC, Pelosi AD, Martins RN, Machado L, Francioni E. Predicting outcomes and complications of percutaneous endoscopic gastrostomy. Endoscopy. 2007;39:333–338.PubMedCrossRefGoogle Scholar
  23. 23.
    Lozoya-Gonzalez D, Pelaez-Luna M, Farca-Belsaguy A, Salceda-Otero JC, Vazquez-Ballesteros E. Percutaneous endoscopic gastrostomy complication rates and compliance with the American Society for Gastrointestinal Endoscopy guidelines for the management of antithrombotic therapy. JPEN J Parenter Enteral Nutr. 2012;36:226–230.PubMedCrossRefGoogle Scholar
  24. 24.
    Birgisson S. Percutaneous endoscopic gastrostomy in Iceland over 10 year period: a retrospective study of indications, complications and ethical issues. Laeknabladid. 2012;98:97–102.PubMedGoogle Scholar
  25. 25.
    Malmgren A, Hede GW, Karlstrom B, et al. Indications for percutaneous endoscopic gastrostomy and survival in old adults. Food Nutr Res. 2011;55.Google Scholar
  26. 26.
    Lee SP, Lee HL, Kim DC, et al. Percutaneous endoscopic gastrostomy using 10-cc syringe tubes for amyotrophic lateral sclerosis patients with limited mouth opening. Endoscopy. 2012;44 Suppl 2 UCTN:E190–E191.Google Scholar
  27. 27.
    Counihan T, Napolitano LM, Heard SO. Transnasal insertion of percutaneous endoscopic gastrostomy in a patient with intermaxillary fixation: case report. J Trauma. 1996;41:530–532.PubMedCrossRefGoogle Scholar
  28. 28.
    Safadi BY, Marks JM, Ponsky JL. Percutaneous endoscopic gastrostomy. Gastrointest Endosc Clin N Am. 1998;8:551–568.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sang Pyo Lee
    • 1
  • Kang Nyeong Lee
    • 2
    Email author
  • Oh Young Lee
    • 2
  • Hang Lak Lee
    • 2
  • Dae Won Jun
    • 2
  • Byung Chul Yoon
    • 2
  • Ho Soon Choi
    • 2
  • Seung Hyun Kim
    • 3
  1. 1.Department of Internal Medicine, Digestive Disease CentreKonkuk University School of MedicineSeoulKorea
  2. 2.Department of Internal MedicineHanyang University College of MedicineSeoulKorea
  3. 3.Department of NeurologyHanyang University College of MedicineSeoulKorea

Personalised recommendations