ABSTRACT
Percutaneous endoscopic gastrostomy (PEG) has become a commonly performed procedure to provide nutritional support to chronically ill patients. Following a PEG-related death, we retrospectively reviewed our complication rate with that of the published values. In the past 48 months at Madigan Army Medical Center and Eisenhower Army Medical Center, 147 PEGs have been performed. We have had 20 minor complications and 5 major complications, with 2 reported deaths directly related to the procedure. Minor complications included 14 cases of localized cellulitis and 5 cases of prolonged ileus. The major complications included two cases of necrotizing fasciitis (both fatal), two cases of tube extubation within 24 hours, both resulting in surgical gastrostomy, and one bowel obstruction requiring laparotomy. Both patients who developed necrotizing fasciitis had several predisposing factors including diabetes, malnutrition, obesity, and long-term hospitalization. In conclusion, we believe PEG is an extremely valuable procedure which should be utilized with caution in the immunocompromised or morbidly obese patient.
Subject(s)
Endoscopy, Gastrointestinal/adverse effects , Fasciitis/etiology , Gastrointestinal Diseases/etiology , Gastrostomy/adverse effects , Adult , Aged , Aged, 80 and over , Fasciitis/mortality , Fasciitis/pathology , Female , Gastrointestinal Diseases/mortality , Gastrostomy/methods , Georgia , Hospitals, Military , Humans , Male , Middle Aged , Morbidity , Necrosis , Prospective Studies , Skin , WashingtonABSTRACT
The impact of video endoscopy on surgical resident training was assessed by an analysis of 1531 endoscopic procedures (1057 video endoscopy and 474 fiberoptic endoscopy) and a standardized questionnaire response of surgical staff and residents. Video endoscopy provided advantages in the following areas: 1) Technical. Superior quality of image with a significantly greater resolution. 2) Procedural. Multiple simultaneous viewers for teaching and increased coordination for therapeutic maneuvers. 3) Educational. "Freeze frame" capability for real time teaching; video taping for subsequent consultation, review, or teaching conference, video tape evaluation at preoperative conferences, and archive of video tape for teaching file. 4) Documentation. For use review and quality assurance or for patient education. 5) Research. Investigation of video image enhancement techniques. 6) Physical comfort. Relief of many causes of strain and fatigue and elimination of potential danger to the endoscopist in certain therapeutic maneuvers. Residents learned video and fiberoptic endoscopy equally well, requiring only 3 to 5 procedures to learn each type of system. Experience in this teaching program indicates a decided advantage to incorporating video endoscopy into surgical residency training. After more than 1000 video endoscopy procedures, the novelty has worn off but enthusiasm persists; the video system is now a workhorse that provides greater technical capabilities and broader educational horizons while returning endoscopy to the realm of surgical education.
Subject(s)
Endoscopy/methods , General Surgery/education , Video Recording , Digestive System Surgical Procedures , Endoscopy/education , Fiber Optic Technology/instrumentation , HumansABSTRACT
Of 1,504 endoscopic procedures in a two and one half year period, 296 (20%) were performed prior to elective surgery or an invasive diagnostic procedure. From these "pre-op clearance" procedures, there were 66 (22%) positive findings. Due to these endoscopic findings, 29 patients (44% of positive findings or 10% of all pre-operative evaluations) had an alteration of planned treatment. The indications for preoperative endoscopy in these patients were: atypical symptoms of diagnosed gastrointestinal (GI) tract disease, symptoms of GI tract disease unrelated to an elective surgical procedure, history of prior GI tract disease which may complicate elective surgery, and evaluation of a portion of the GI tract prior to operating on that segment. Judicious use of preoperative endoscopy following the above guidelines can decrease adverse surgical outcomes.
Subject(s)
Endoscopy , Gastrointestinal Diseases/surgery , Aged , Colonoscopy , Duodenoscopy , Esophagoscopy , Evaluation Studies as Topic , Female , Gastrointestinal Diseases/diagnosis , Humans , Time FactorsABSTRACT
A case report of sclerosing mesocolitis is presented. This is an unusual and poorly understood entity. A 49-year-old woman presented with episodic abdominal pain and a palpable abdominal mass. A fibrotic mass causing extensive compression of her cecum and transverse colon was found at laparotomy. The pathologic findings and treatment of sclerosing mesocolitis are discussed.
