ABSTRACT
ABSTRACT BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is an important option for enteral nutrition for both children and adults. It is considered a safe, effective, and advantageous technique in comparison to other complementary feeding routes. It allows continuous feeding, the feeding of patients with swallowing disorders due to neurological causes or others, and the administration of non-palatable diets or medications, all with low rates of complications and mortality. OBJECTIVE: This study aimed to evaluate the main indications and complications of PEG in pediatric patients. In addition, the impact on the nutritional status of patients undergoing PEG was also compared with weight, body mass index (BMI), and height according to references from the World Health Organization. METHODS: This observational and retrospective study included 152 children and adolescents who underwent PEG between January/2003 and December/2018. Patients up to 18 years of age at the time of the procedure were included. Complications related to the procedure were classified as minor or major. Patients with PEG indication for nutritional supplementation were evaluated for weight gain, height, and BMI, using the Z score at the day of the procedure and six months, 1 year, and 2 years after the procedure. RESULTS: Indications for PEG were: swallowing disorder of neurological cause (67.1%), need for nutritional supplementation (25%), swallowing disorder of mechanical origin (6.6%), and indication of gastric decompression (1.3%). Minor complications occurred in 57.8% of patients and major complications in 9.8% of patients. The traction technique corresponded to 92.1% and puncture to 7.9%. The death rate was 1.3%. Thirty-eight patients had an indication for nutritional supplementation. In these patients, there was a gradual increase in both BMI and weight, reaching statistically significant differences (P=0.0340 and P= 0.0105, respectively). These differences were more evident in chronic renal disease patients. Height did not vary significantly (P=0.543). CONCLUSION: PEG proved to be an advantageous option as an auxiliary feeding method in pediatric patients. Dysphagia of neurological origin was the main indication followed by the need for nutritional supplementation. PEG has low frequency of major complications and mortality. This study also showed the importance of PEG in patients who need nutritional supplementation, as it enabled patients to move from undernutrition to normal weight ranges.
RESUMO CONTEXTO: A gastrostomia endoscópica percutânea (GEP) é uma importante opção de nutrição enteral para crianças e adultos, sendo considerada uma técnica segura, eficaz e vantajosa em comparação às outras vias de alimentação complementar. Permite a alimentação contínua, a alimentação em pacientes com distúrbios de deglutição de causa neurológica ou outros, a administração de dietas ou medicamentos não palatáveis, todos com baixos índices de complicações e mortalidade. OBJETIVO: Avaliar as principais indicações e complicações de pacientes pediátricos submetidos à GEP e o impacto no estado nutricional de pacientes submetidos à GEP para suplementação nutricional, comparando peso, índice de massa corporal (IMC) e estatura com referências da Organização Mundial de Saúde. MÉTODOS: Estudo observacional e retrospectivo de 152 crianças e adolescentes submetidos à GEP, no período de janeiro/2003 a dezembro/2018. Foram incluídos pacientes até 18 anos de idade na época do procedimento. As complicações relacionadas ao procedimento foram divididas em menores e maiores. Pacientes com indicação de GEP para suplementação nutricional foram avaliados quanto ao ganho de peso, altura e IMC, por meio do escore Z no dia do procedimento e 6 meses; 1 ano; e 2 anos após o procedimento. RESULTADOS: As indicações para GEP foram distúrbio de deglutição de causa neurológica (67,1%), necessidade de suplementação nutricional (25%), distúrbio de deglutição de origem mecânica (6,6%), e indicação de descompressão gástrica (1,3%). Complicações menores ocorreram em 57,8% dos pacientes e complicações maiores em 9,8%. A técnica de tração correspondeu a 92,1% e a punção, 7,9%. A taxa de mortalidade foi de 1,3%. Trinta e oito pacientes tinham indicação de suplementação nutricional. Nestes, houve aumento gradativo tanto do IMC quanto do peso, com variação estatisticamente significativa da mediana P=0,0340 e P=0,0105, respectivamente, mais evidente nos pacientes renais crônicos. A altura não variou significativamente (P=0,543). CONCLUSÃO: A GEP mostrou-se uma opção vantajosa como forma auxiliar de alimentação em pacientes pediátricos, tendo como principais indicações a disfagia de causa neurológica e a necessidade de suplementação nutricional, com baixa prevalência de complicações maiores e mortalidade. Este estudo também mostrou a importância da GEP em pacientes com necessidade de suplementação nutricional, possibilitando a passagem dos pacientes desnutridos para escores nutricionais de peso adequados à idade.
Subject(s)
Humans , Child , Adolescent , Adult , Gastrostomy/adverse effects , Malnutrition , Retrospective Studies , Treatment Outcome , Enteral NutritionABSTRACT
Resumen La pancreatitis aguda secundaria a la obstrucción de la papila mayor causada por la migración del balón interno es uno de los efectos secundarios poco frecuentes, pero potencialmente graves relacionados con el uso de gastrostomías endoscópicas percutáneas (PEG). Hasta ahora solo existen 15 casos reportados en el mundo, presentamos el que para nuestro conocimiento sería el caso número 16 en la literatura internacional.
Abstract Acute pancreatitis secondary to major papilla obstruction caused by intragastric balloon migration is one of the rare but potentially severe side effects associated with the use of percutaneous endoscopic gastrostomy (PEG). To date, there are only 15 cases reported worldwide. This article presents a case that, to the best of our knowledge, is the sixteenth case reported in the international literature.
Subject(s)
Humans , Male , Female , Pancreatitis , Gastrostomy , LiteratureABSTRACT
La gastrostomía endoscópica percutánea (GEP) se utiliza como alternativa de la alimentación enteral/nasoenteral en situaciones en las que la alimentación por vía oral a largo plazo no es eficaz o no se tolera. Se prefiere principalmente en pacientes con afecciones neurológicas y, además, como apoyo de la nutrición en pacientes con enfermedades cardíacas congénitas, fibrosis quística, enfermedad intestinal inflamatoria y diversas enfermedades orofaríngeas. Si bien la colocación es sencilla en comparación con muchos procedimientos invasivos, presenta complicaciones, que incluyen desde la infección de la herida hasta la muerte. La GEP exige personal médico experimentado, antibióticos profilácticos adecuados e información exhaustiva para los pacientes o sus familias sobre el procedimiento y los cuidados posteriores. Presentamos una complicación rara, aunque importante, que surgió durante el reemplazo de la sonda de gastrostomía después del método de "corte y empuje". El tope, que debe llegar hasta el extremo distal del estómago, se desplazó hacia arriba, hasta el esófago proximal, y causó una úlcera profunda en la mucosa esofágica y una hemorragia masiva.
Percutaneous endoscopic gastrostomy (PEG) is used as an alternative to enteral/nasoenteral feeding in situations where long-term oral feeding is ineffective or not tolerated. It is mostly preferred in patients with neurological conditions and also to support nutrition in patients with congenital heart diseases, cystic fibrosis, inflammatory bowel disease, and various oropharyngeal diseases. Although it is easily applicable compared to many invasive procedures, it has complications ranging from wound infection to death. PEG requires experienced medical personnel, appropriate prophylactic antibiotics and exhaustive information to the patients or their families about the procedure and subsequent care. We present a rare but important complication during the replacement of the gastrostomy tube subsequent to the "cut and push" method. The bumper portions, which should move to the distal end of the stomach, moved upwards to the proximal esophagus, caused a deep ulcer in the esophageal mucosa and a massive hemorrhage.
Subject(s)
Humans , Male , Child, Preschool , Postoperative Complications/diagnosis , Gastrostomy/adverse effects , Esophageal Diseases/etiology , Gastrointestinal Hemorrhage/etiology , Gastrostomy/methods , Fatal Outcome , Endoscopy , Esophageal Diseases/diagnosis , Gastrointestinal Hemorrhage/diagnosisABSTRACT
Introducción: la gastrostomía endoscópica percutánea (GEP) se ejecuta cada vez con mayor frecuencia en ancianos con alteraciones deglutorias, sin importar su condición física, mental o funcional. En nuestro medio se desconocen sus complicaciones y desenlaces. Objetivo: el propósito del estudio es determinar las indicaciones, tasa de complicaciones y desenlaces a corto y largo plazo en el seguimiento de hasta de 5 años. Pacientes y métodos: estudio descriptivo retrospectivo de pacientes mayores de 60 años de edad hospitalizados con indicación de gastrostomía endoscópica percutánea y atendidos en la Clínica Fundadores en el período comprendido entre enero de 2008 y junio del 2013; fueron excluidos pacientes menores de 60 años, realización de gastrostomía abierta o GEP fallida. Se realizó revisión de historias clínicas y seguimiento telefónico de los pacientes. Resultados: de los 135 pacientes con indicación de GEP, 96 fueron incluidos, media de edad 77,5±9 años, 38 hombres (39,5%). La indicación para la GEP fue la incapacidad para la deglución por evento cerebrovascular (32,89%), demencia (30,26%) u otras causas (36,85%). La hipertensión arterial fue la comorbilidad más frecuente. La complicación más común asociada con la GEP fueron los síntomas gastrointestinales (32,9%). No hubo mortalidad asociada con el procedimiento. Conclusiones: la GEP es segura para el aporte enteral a los pacientes ancianos, sin embargo, no demostró beneficio en aquellos pacientes asociados con demencia. Es importante un manejo interdisciplinario previo para definir la alimentación por gastrostomía en ancianos.
Introduction: Percutaneous endoscopic gastrostomies (PEG) are performed more and more frequently in elderly patients suffering from problems with swallowing. The procedure is used regardless of patients physical, mental and functional status, but little is known about complications and outcomes here in Colombia. Objective: The purpose of the study is to determine indications for performance of PEG, rate of complications, and outcomes in short and long term follow-ups (five years). Patients and methods: This is a retrospective and descriptive study of patients over the age of 60 who were hospitalized for percutaneous endoscopic gastrostomy at the Clínica Fundadores between January 2008 and June 2013. Patients younger than 60 years of age, those who had open gastrostomies, and those whose PEG procedure failed were excluded. Patients medical records were reviewed and telephone follow-ups of patients were conducted. Results: Of the 135 patients with indications for PEG, 96 patients were included. The mean age was 77.5 ± 9 years, and 38 of the patients were men (39.5%). The reasons for performance of PEG were inability to swallow due to a cerebrovascular event (32.89%), dementia (30.26 %) and other causes (36.85). Hypertension was the most common comorbidity. The most common complications associated with PEG were gastrointestinal symptoms (32.9%). There was no mortality associated with the procedure. Conclusions: PEG is a safe way for elderly patients to receive enteral tube feeding (ETF), but we found no benefit for patients with dementia. Interdisciplinary management prior to the procedure is important to determine whether or not ETF should be used for elderly patients.
Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Aged , Gastrostomy , Postoperative ComplicationsABSTRACT
Introducción: se han descrito ventajas y complicaciones de la gastrostomía endoscópica percutánea como método de elección cuando el paciente tiene dificultad para alimentarse vía oral. Objetivo: reportar la experiencia con la gastrostomía endoscópica percutánea como procedimiento seguro en niños con enfermedad crónica o en estado crítico con indicación de soporte nutricional. Pacientes y Métodos: estudio prospectivo, descriptivo y transversal durante un año. Variables estudiadas: edad, sexo, indicación, patología de base, lugar del procedimiento, éxito técnico y complicaciones. Resultados: 11 niños, 8 (72,72%) masculinos, edad promedio 9,47 años (rango: 9meses-15años). Todos alimentados previamente por sonda nasogástrica; desnutrición crónica 72,72% y aguda 27,28%. Patología de base: trastorno de deglución 3, parálisis cerebral 2, síndrome de West 2, en postoperatorio: uno con meningioma y otro hemangioma de fosa posterior, un caso por cada patología: epilepsia refractaria y síndrome de Guilland Barre. Se efectuó el procedimiento en quirófano en 6 pacientes, 3 en terapia intensiva y 2 en sala de endoscopia. Un total de 12 procedimientos, éxito en 11/12 (91,66%), un caso se colocó el gastróstomo en el segundo intento. Inicio de alimentación enteral en un promedio de 8,99 horas (rango: 4-18 horas). Complicaciones inmediatas: una infección del estoma, una falla de entrar en estómago y un sangrado por herida de piel. Ninguna complicación tardía. Conclusiones: la gastrostomía endoscópica percutánea es un procedimiento seguro y de elección para la nutrición enteral prolongada en pacientes con enfermedad crónica y crítica con baja tasa de complicaciones.
SAFETY PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CHILDREN WITH CHRONIC DISEASE OR IN CRITICAL CONDITION.
Introduction: We have reported advantages and complications of percutaneous endoscopic gastrostomy as a method of choice when the patient has difficulty feeding orally. Objective: To report our experience with percutaneous endoscopic gastrostomy as a safe procedure in children with chronic disease or critical condition, with indicating nutritional support. Patients and Methods: A prospective, descriptive and transversal for a year. Variables studied: age, sex, indication, underlying disease, instead of the procedure, technical success and complications. Results: 11 children, 8 (72.72%) male, mean age 9.47 years (range: 9 months-15 years old). All previously fed by nasogastric tube, chronic malnutrition and acute 72.72% 27.28%. Basic Pathology: Swallowing Disorder 3 CP 2 West Syndrome 2, postoperatively: one with meningioma and other posterior fossa hemangioma, one of every pathology: refractory epilepsy Guilland Barre syndrome. The procedure was performed in 6 patients in the operating room, intensive care 3 and 2 endoscopy room. A total of 12 procedures, successful in 11/12 (91.66%), a case is put the gastróstomo on the second attempt. Home enteral feeding at an average of 8.99 hours (range: 4-18 hours). Immediate complications: infection of the stoma, failure to enter stomach and bleeding skin wound. No late complication. Conclusions: Percutaneous endoscopic gastrostomy is a safe procedure of choice for long-term enteral nutrition in patients with chronic and critical low complication rate.
ABSTRACT
La gastrostomía endoscópica percutánea (GEP) es la técnica de elección para instaurar una vía de alimentación en pacientes que requieren soporte nutricional especial por más de 4 semanas; sin embargo, por ser una intervención realizada de forma percutánea, la incapacidad para evidenciar transiluminación de la pared abdominal, así como la no obtención de convexidad con la dígito-presión son consideradas usualmente contraindicaciones para la realización del procedimiento. Se reporta un caso en el cual a pesar de presentarse una contraindicación para la realización de GEP, esta se hizo bajo guía laparoscópica, proporcionando así una alternativa mínimamente invasiva y evitando la realización de un procedimiento quirúrgico abierto.
Percutaneous endoscopic gastrostomy (PEG) is the choice technique to establish a feeding route for patients that requiring special nutritional support for more than 4 weeks; however, to be an intervention performed percutaneously, the inability to demonstrate transillumination of the abdominal wall and the failure to obtain convexity with the finger-pressure are usually considered contraindications for its realization. This report is about a case in which spite of a major contraindication for PEG, it was performed under laparoscopic guidance, thus providing a minimally invasive alternative, avoiding the realization of an open surgical procedure.
Subject(s)
Humans , Male , Adult , Gastrostomy , LaparoscopyABSTRACT
A gastrostomia endoscópica percutânea (GEP) é um método relativamente simples e seguro de acesso enteral para pacientes com disfagia. Esse procedimento é normalmente realizado durante internação hospitalar. A utilização da GEP como procedimento ambulatorial ainda não está bem estabelecida na literatura. Os objetivos principais desse estudo foram investigar a viabilidade e segurança da GEP ambulatorial e o impacto clínico do momento de realização do procedimento (pré, per ou pós-tratamento) em pacientes com câncer de cabeça e pescoço (CCP). Em ensaio clínico prospectivo não controlado, pacientes com CCP em bom estado geral foram selecionados e incluídos em um protocolo de acompanhamento de GEP ambulatorial. O estudo foi dividido em 2 partes sequenciais e complementares, a primeira para avaliação da taxa de sucesso e de complicações precoces do procedimento, e a segunda para avaliação da taxa global de complicações em relação ao momento do tratamento. Na primeira parte do estudo, foram selecionados 136 pacientes. Três pacientes foram excluídos do estudo no pré-operatório, 4 foram hospitalizados pós-procedimento e 129 (94,8%) receberam alta hospitalar 3 horas após o procedimento. A taxa de complicações menores foi de 17,6% (dor local 7,4%; infecção de ferida 6,6%; dor abdominal 2,9%; hematoma 0,7%). Complicações maiores ocorreram em 2,2% (sepultamento do retentor interno da sonda 1,5%; saída acidental precoce da sonda 0,7%) dos procedimentos. Não houve óbitos. Na segunda fase do estudo, um total de 201 pacientes foram submetidos à GEP ambulatorial, sendo 58 (28,9%) pré-tratamento, 48 (23,9%) durante o tratamento e 95 (47,5%) pós-tratamento para a doença de base. Houve complicações em 55,7% dos pacientes no acompanhamento de longo prazo (precoces em 16,9% e tardias em 49,8%; maiores em 6,5% e menores em 55,2%). As taxas de complicações foram semelhantes às descritas para pacientes hospitalizados. A avaliação das variáveis estudadas (faixa etária, sexo e momento da realização da GEP) não mostrou associação com a taxa de complicações totais (precoces ou tardias, menores ou maiores). Não houve diferença significativa nas taxas de complicações das GEPs realizadas no pré, per ou pós-tratamento. A realização ambulatorial de GEP é viável e segura em pacientes com CCP em boas condições clinicas. Internações desnecessárias são evitadas e os custos hospitalares são reduzidos.
Percutaneous endoscopic gastrostomy (PEG) is a relatively simple and safe method of providing enteral access for patients with dysphagia. The procedure is usually performed in hospitalized patients. The use of PEG as an outpatient procedure has not been well established in the literature. The main objectives of this study were to investigate the feasibility and safety of outpatient PEG, and the clinical impact of the timing of the procedure (pre, peri or post-treatment) in a selected group of head and neck cancer (HNC) patients. In this prospective clinical study, HNC subjects in good condition were selected and enrolled in a close protocol of outpatient PEG. The study was divided into 2 sequential and complementary parts, the first part to evaluate the success rate and early complications, and the second part to evaluate the overall complication rate in relation to treatment timing. At the first part of the study, 136 patients were selected. Three patients were excluded preoperatively, four were hospitalized after the procedure and 129 (94.8%) weredischarged three hours after the procedure. The rate of minor complications was 17.6% (local pain 7.4%, wound infection 6.6%, abdominal pain 2.9%, hematoma 0.7%). Major complications occurred in 2.2% (buried bumper syndrome 1.5%, accidental early tube dislodgment 0.7%). There was no mortality. At the final part of the study, a total of 201 patients underwent ambulatory PEG, 58 (28.9%) pretreatment, 48 (23.9%) during treatment and 95 (47.5%) after treatment for the underlying malignant disease. There were complications in 55.7% of patients in the long-term follow-up (16.9% early and 49.8% late, 6.5% major and 55.2% minor). Complication rates were similar to those described for hospitalized patients. The evaluation of clinical-demographic variables (age, sex and timing of PEG) was not associated with significant statistical difference for complication rates (early or late, major or minor). There was also no significant statistical difference for the complication rates of pre, peri or post-treatment PEGs. Ambulatory PEG is viable and safe in HNC patients in good clinical condition. Unnecessary admissions are avoided nd costs of hospitalization are reduced.
Subject(s)
Humans , Male , Female , Ambulatory Surgical Procedures , Gastrostomy , Gastrostomy/adverse effects , Head and Neck Neoplasms/therapy , Health EvaluationABSTRACT
La Gastrostomía Endoscópica Percutánea fue descrita por primera vez en 1980 y pronto tuvo gran auge por ser un método fácil, seguro y sencillo. El benefi cio principal es el de iniciar la alimentación enteral temprana y el de ser un procedimiento con bajo riesgo, bajo costo-benefi cio, con reducción de la estancia hospitalaria y menor riesgo de infección en comparación con la gastrostomía quirúrgica. Demostrar que la gastrostomía endoscópica percutánea es un método seguro con pocas complicaciones que pueden garantizar la alimentación de los pacientes con enfermedades que impiden la alimentación oral. Se colocaron 21 gastrostómos por vía percutánea utilizando la técnica PULL. De los 21 procedimientos realizados, 15 (71,42%) fueron pacientes masculinos y 6 (28,57%) femeninas, dentro de los cuales 6 cursaban con défi cit neurológico tipo enfermedad cerebro vascular (28,57%), 3 tumores esofágico estenosante (14,28%), 2 correspondieron a traumatismo craneoencefálico (9,5%), y 2 lesiones de ocupación de espacio cerebral (9,5%), el restante corresponde a un paciente por cada una de las siguientes patología con un porcentaje de 4,76 respectivamente: lesiones de ocupación de espacio a nivel medular, cáncer de nasofaringe, cáncer de amígdala, adenocarcinoma de unión esófago gástrica, tumor maxilar operado con limitación apertura bucal, cáncer epidermoide cuerda vocal, cáncer de laringe y fístula gastroesofágica. Entre los servicios con mayor solicitud del procedimiento se encuentra Neurología y Oncología con 6 cada uno (28,57% respectivamente), Neurocirugía 5 (23,80%), Gastroenterología 2 (9,5%), UTI 1(4,76%) y 1(4,76%) Ambulatorio. De estos 21 procedimientos realizados no tuvimos complicaciones antes, durante ni después de la colocación del gastrostómo...
Percutaneous Endoscopic Gastrostomy (PEG) was fi rst described in 1980, and soon became a boom as a result of being and easy, safe and simple method. The main benefi t is that of starting an early enteric feed and of being a low risk, low cost-benefi t procedure, with a reduced inpatient term and a lower risk of infection if compared with surgical gastrostomy. Demonstrating that percutaneous endoscopic gastrostomy is a safe method, with few complications, which may guarantee feeding patients with diseases preventing oral feeding. 21 PEG tubes were placed by using the PULL technique. Out of the 21 performed procedures, 15 (71.42%) were male patients and 6 (28.57%) were female, and 6 of them presented stroke-related neurological defi cits (28.57%), 3 stenosing esophageal tumors (14.28%), 2 corresponded to craneoencephalic trauma (9,5%) and 2 lesions of intracranial space occupation (9,5%); the rest corresponds to one patient per each of the pathologies below, with a 4.76 ratio respectively: spinal space occupying lesions, nasopharyngeal cancer, tonsil cancer, gastroesophageal junction adenocarcinoma, limitation of mouth opening after maxillary tumor surgery, vocal cord epidermoid cancer, larynx cancer, and gastroesophageal fi stula. Services that requested more the services were: Neurology and Oncology, 6 requests each (28.57%, relevantly), Neurosurgery: 5 (23.80%), Gastroenterology: 2 (9.5%), ICU: 1 (4.76%), and Outpatient: 1 (4.76%). Of the 21 performed procedures, no complication arose either before, during or after placing the PEG tube...