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Habib T, Mulrooney NS, Grabie Y, Maruf M, Kasapira S. Ethical Considerations of Percutaneous Endoscopic Gastrostomy Tube Placement in a Patient With Creutzfeldt-Jakob Disease and Advanced Dementia. HCA HEALTHCARE JOURNAL OF MEDICINE 2025; 6:99-104. [PMID: 40071192 PMCID: PMC11892411 DOI: 10.36518/2689-0216.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2025]
Abstract
Background Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative condition that is not easily diagnosed and has no curative treatments available, essentially requiring palliative measures, including tube feeding. Nonetheless, data shows that the endoscope used for percutaneous endoscopic gastrostomy (PEG) tube insertion can be a vector for CJD transmission. Case Presentation We discuss the case of an elderly patient diagnosed with CJD, requiring tube feeding. Multiple specialists were consulted, and they were unable to reach an agreement on the best approach. Eventually, the hospital ethics committee intervened, and the family agreed to comfort measures only. This case report sheds light on the ethical challenges surrounding the use of endoscopically assisted PEG tube placement for patients with confirmed or suspected CJD. Conclusion Ethical consideration for patients with dementia, especially with CJD, includes evaluating harm and benefit, considering legal and societal responsibilities, respecting autonomy, and managing transmission risks. Based on our findings, we encourage interdisciplinary collaboration when navigating complex medical decision-making for patients with human prion diseases and advanced dementia.
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Affiliation(s)
- Toni Habib
- Staten Island University Hospital, Staten Island, New York
| | | | - Yisroel Grabie
- Staten Island University Hospital, Staten Island, New York
| | - Mohammad Maruf
- Staten Island University Hospital, Staten Island, New York
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Yang H, Yan G, Chen M, Xian J, Zhou W, Guan Z, Yao C. Endoscopic resection of benign breast tumors via a single axillary incision using the insufflation method: a preliminary summary report. Updates Surg 2024; 76:2933-2942. [PMID: 39212928 DOI: 10.1007/s13304-024-01972-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
Conventional benign tumor excision leaves scars on the skin surface of the breast, which is unacceptable for young patients. The feasibility and clinical results of endoscopic resection of benign breast tumors through a single axillary incision via an inflatable method were evaluated. METHODS Clinicopathological data from 62 patients who underwent this procedure from June 2022 to July 2023 were retrospectively collected. The surgical success rate, number of tumors excised, operative time, intraoperative conditions, postoperative complications, and clinical outcomes were analyzed. RESULTS A total of 144 benign tumors were resected, and the surgical success rate was 100% (62/62). The time required to resect tumors located in the inner quadrant with larger diameters was shorter than the time to resect tumors located in the outer quadrant with smaller tumors. Sixty-two patients experienced reduced intraoperative bleeding and did not experience skin burns, incision infections, or poor healing. However, all patients experienced varying degrees of subcutaneous emphysema during the postoperative period. Fourteen patients experienced minor local effusions, and 3 patients experienced mild upper limb dysfunction, which resolved within one month. During the six-month follow-up period, there were no cases of tumor recurrence or new tumors. The ABNSW score was above 14 points, and patient satisfaction was high. CONCLUSION Endoscopic resection of benign breast tumors through a single incision in the axilla via the inflatable method could quickly remove lesions larger than 3.0 cm. This method also results in hidden scars and good cosmetic effects on the shape of the breast. This is a new and effective treatment for benign breast tumors. TRIAL REGISTRATION This retrospective study was registered in the National Medical Research Registry filing system ( https://www.medicalresearch.org.cn ) (No. MR-44-22-007981) and recorded in the Medical Research Division of our hospital (No. NYXJS-22-021).
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Affiliation(s)
- Huangyun Yang
- Department of Emergency Gynecology, Xiamen Women and Children's Hospital, Affiliated to Xiamen University, The Affiliated Women and Children's Hospital of Xiamen University, No. 10 Zhenhai Road, Siming District, Xiamen City, 361000, Fujian, People's Republic of China
| | - Guobiao Yan
- Department of Breast Surgery, School of Medicine, The Sixth Affiliated Hospital, South China University of Technology (SCUT), Nanhai District, Foshan City, 528225, Guandong, People's Republic of China
| | - Ming Chen
- Department of Breast Surgery, School of Medicine, The Sixth Affiliated Hospital, South China University of Technology (SCUT), Nanhai District, Foshan City, 528225, Guandong, People's Republic of China
| | - Jiayi Xian
- Department of Breast Surgery, School of Medicine, The Sixth Affiliated Hospital, South China University of Technology (SCUT), Nanhai District, Foshan City, 528225, Guandong, People's Republic of China
| | - Wen Zhou
- Medical Research Unit, School of Medicine, The Sixth Affiliated Hospital, South China University of Technology (SCUT), Nanhai District, Foshan City, 528225, Guandong, People's Republic of China
| | - Ziyun Guan
- Office of the Dean, School of Medicine, The Sixth Affiliated Hospital, South China University of Technology (SCUT), Nanhai District, Foshan City, 528225, Guandong, People's Republic of China.
| | - Chengcai Yao
- Department of Breast Surgery, School of Medicine, The Sixth Affiliated Hospital, South China University of Technology (SCUT), Nanhai District, Foshan City, 528225, Guandong, People's Republic of China.
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Wang D, Peng R, Huang Y, Zhou J, Long Z, Wang J, Zhang D. Safety Study of Percutaneous Gastroscopic Gastrostomy in Patients After Ventriculoperitoneal Shunt. Am Surg 2024; 90:3262-3266. [PMID: 39030672 DOI: 10.1177/00031348241265147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
OBJECTIVE To evaluate the safety study of percutaneous gastroscopic gastrostomy in patients after ventriculoperitoneal shunt. METHODS We conducted a retrospective analysis of neurosurgical patients who underwent VPS and PEG at our hospital between January 2012 and November 2023. Patients were divided into 2 groups: VPS group and VPS followed by PEG gruop. Patients received routine antibiotic prophylaxis before the procedure, continued for 48 hours. Follow-up included monitoring immediate complications, particularly wound infection, intracranial infection, neurologic status deterioration, and shunt dysfunction. Routine follow-up visits were conducted post-discharge. RESULTS In the VPS group (n = 778), the incidence of intracranial infection was 3.08%. Among patients with PEG after VPS, the time interval between procedures ranged from 13 to 685 days. The mean follow-up period was 22 (1-77) months, with no deaths or further complications. CONCLUSION Performing PEG more than 13 days after VPS does not significantly increase the risk of intracranial infections or PEG-associated infections, making it a relatively safe procedure.
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Affiliation(s)
- Dexian Wang
- Department of Gastroenterology, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Run Peng
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Yebin Huang
- Department of Gastroenterology, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jun Zhou
- Department of Gastroenterology, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Zhihua Long
- Department of General Surgery, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jianjun Wang
- Department of Neurosurgery, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Dejian Zhang
- Department of Emergency, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
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dos Santos JM, Pedreira LC, Góes RP, de Souza MAA, Baixinho CRSL, Ortega J, De La Rosa RN, Sousa AR, da Silva VA, Pinto IS, Santos JLP, Vivas LC, de Oliveira LMS. Caregivers' Mastery in Handling Gastrostomy at Home after Educational Intervention: Qualitative Descriptive Study. Healthcare (Basel) 2024; 12:2147. [PMID: 39517359 PMCID: PMC11545758 DOI: 10.3390/healthcare12212147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 10/10/2024] [Accepted: 10/11/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Effective hospital discharge planning is crucial, particularly in educating caregivers on handling medical devices. This education helps manage the patient's signs and symptoms, prevents post-discharge complications, and reduces early readmissions. This study aimed to understand aspects involved in the acquisition of mastery by home caregivers, in handling care of a patient who just underwent gastrostomy, after educational intervention during hospitalization and telemonitoring upon return home. METHODS Qualitative descriptive study. It followed 15 caregivers of people with percutaneous endoscopic gastrostomy. The intervention took place between November 2022 and July 2023 in the neuromusculoskeletal unit of a Brazilian university hospital. RESULTS The educational intervention had four stages. In stage 1, caregivers felt confused and uncertain about managing PEG. By stage 2, they expressed a desire to be capable of handling care, especially in the event of potential complications, and showed increased awareness and engagement. Stage 3 highlighted the effectiveness of hands-on training with feedback from professionals. In stage 4, during monitoring, several complications were noted, including granuloma formation in the stoma, tube obstruction, and accidental tube loss. However, caregivers demonstrated the ability to handle these situations, indicating the effectiveness of the training and telemonitoring interventions. CONCLUSIONS Nursing professionals should consider various factors when training caregivers in a hospital setting, including providing adequate space, allocating sufficient time for educational interventions, offering both theoretical and practical demonstrations, ensuring effective communication, and taking into account the caregivers' context, as they play a direct role in acquiring a safe and effective skill set.
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Affiliation(s)
- Jeferson Moreira dos Santos
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
| | - Larissa Chaves Pedreira
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
| | - Roberta Pereira Góes
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
| | | | | | - Johis Ortega
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 248153, USA; (J.O.); (R.N.D.L.R.)
| | - Rosseirys Noelia De La Rosa
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 248153, USA; (J.O.); (R.N.D.L.R.)
| | - Anderson Reis Sousa
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
| | - Valdenir Almeida da Silva
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
| | - Ivana Santos Pinto
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
| | - Jéssica Lane Pereira Santos
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
| | - Letícia Chicharo Vivas
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
| | - Lélia Mendes Sobrinho de Oliveira
- School of Nursing, Federal University of Bahia, Salvador 40110-907, Brazil; (L.C.P.); (R.P.G.); (A.R.S.); (V.A.d.S.); (I.S.P.); (J.L.P.S.); (L.C.V.); (L.M.S.d.O.)
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Lee S, Ko A, Park S, Kim KW, Ihn K, Ho IG, Kim SH, Kim HD, Lee JS, Kang HC. Efficacy of enteral feeding by gastrostomy tube placement in patients with Lennox-Gastaut syndrome on body weight and days of hospitalization: A retrospective case series. Nutr Clin Pract 2024; 39:1202-1211. [PMID: 39030737 DOI: 10.1002/ncp.11177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Lennox-Gastaut syndrome (LGS) is a severe form of drug-resistant epilepsy that begins during childhood and frequently leads to significant neurological impairments. Patients with LGS are likely to receive improper oral nutrition because of issues such as dysphagia and aspiration risk, potentially resulting in long-term tube feeding and eventual gastrostomy tube placement. Therefore, we investigated the effects of gastrostomy tube placement on nutrition outcomes and frequency of hospitalization in LGS. METHODS We retrospectively examined 67 patients diagnosed with LGS who had undergone gastrostomy tube placement between January 2005 and August 2022. Comprehensive clinical data and complications arising from the procedure were collected. Patients' nutrition condition and frequency of hospitalizations were analyzed before and after gastrostomy tube placement. RESULTS Gastrostomy tube placement was performed for the following reasons: high risk of aspiration (50 out of 67, 74.6%), dysphagia (13 out of 67, 25.4%), persistent nasogastric tube feeding (2 out of 67, 3.0%), and severe malnutrition (2 out of 67, 3.0%). After the procedure, z scores for weight-for-age improved significantly, shifting from -3.35 ± 3.57 to -2.54 ± 2.70 over a 2-year interval (P < 0.001). Additionally, the total days of hospitalization and days of hospitalization due to respiratory symptoms reduced significantly from 41.94 ± 51.76 to 15.27 ± 26.68 (P < 0.001) and from 23.75 ± 36.92 to 10.52 ± 22.98 (P = 0.009), respectively. Among the patients, 50 (74.6%) experienced complications resulting from gastrostomy, with a relatively small proportion of major complications (11 out of 67, 16.4%) and no mortality. CONCLUSION Gastrostomy tube placement is a relatively safe procedure with favorable effects on nutrition status and hospitalization rates in patients with LGS.
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Affiliation(s)
- Sangbo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ara Ko
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sowon Park
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyong Ihn
- Division of Pediatric Surgery, Department of Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Geol Ho
- Division of Pediatric Surgery, Department of Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hee Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Choi BC, Lee SJ, Choi E, Lee S, Lee J. The Effect of Oral Diet Training in Indwelling Nasogastric Tube Patients with Prolonged Dysphagia. Nutrients 2024; 16:2424. [PMID: 39125305 PMCID: PMC11314472 DOI: 10.3390/nu16152424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Patients with severe dysphagia are usually fed using a nasogastric tube (NGT). Many patients who receive long-term NGT feeding are unable to obtain sufficient nutrients orally immediately after NGT removal. Thus, a transitional period involving oral diet training is required to transition from NGT feeding to exclusive oral feeding. We aimed to investigate the therapeutic effect of oral diet training in indwelling NGT patients with prolonged dysphagia. Methods: A total of 175 patients who were fed using an NGT for more than 4 weeks were enrolled. Their swallowing function was evaluated by a videofluoroscopic swallowing study (VFSS). During the VFSS, patients received thick and thin barium while the NGT was inserted. Then, the patients underwent a VFSS without an NGT thirty minutes after NGT removal. If a patient had no aspiration with NGT inserted during the VFSS, oral diet training combined with NGT feeding was recommended. Results: Of the 49 indwelling NGT patients who were recommended to receive oral diet training, 39 (79.6%) transitioned to exclusive oral feeding. A transition period of 2-8 weeks was required for them to achieve full oral feeding. Patients who were eligible for oral feeding trials showed no significant aspiration during the VFSS with an NGT inserted and had sufficient cough function. Patients who required prolonged NGT feeding and who could not complete oral trials showed significant aspiration during the VFSS when an NGT was inserted. Conclusions: This study demonstrated that oral diet training combined with NGT feeding is safe in patients with prolonged dysphagia who have sufficient cough function and no aspiration during VFSS. We suggest that if the patient is a proper candidate for NGT removal, direct oral feeding training with an NGT inserted could be a useful therapeutic strategy during the transitional period from long-term NGT feeding to successful oral feeding.
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Affiliation(s)
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (B.-c.C.); (E.C.); (S.L.); (J.L.)
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Huang ST, Wang TG, Peng MC, Chen WM, Jao AT, Tang FT, Hsieh YT, Ho CS, Yeh SM. Predictors for Failed Removal of Nasogastric Tube in Patients With Brain Insult. Ann Rehabil Med 2024; 48:220-227. [PMID: 38830633 PMCID: PMC11217763 DOI: 10.5535/arm.230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/25/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE To construct a prognostic model for unsuccessful removal of nasogastric tube (NGT) was the aim of our study. METHODS This study examined patients with swallowing disorders receiving NGT feeding due to stroke or traumatic brain injury in a regional hospital. Clinical data was collected, such as age, sex, body mass index (BMI), level of activities of daily living (ADLs) dependence. Additionally, gather information regarding the enhancement in Functional Oral Intake Scale (FOIS) levels and the increase in food types according to the International Dysphagia Diet Standardization Initiative (IDDSI) after one month of swallowing training. A stepwise logistic regression analysis model was employed to predict NGT removal failure using these parameters. RESULTS Out of 203 patients, 53 patients (26.1%) had experienced a failed removal of NGT after six months of follow-up. The strongest predictors for failed removal were age over 60 years, underweight BMI, total dependence in ADLs, and ischemic stroke. The admission prediction model categorized patients into high, moderate, and low-risk groups for removal failure. The failure rate of NGT removal was high not only in the high-risk group but also in the moderate-risk groups when there was no improvement in FOIS levels and IDDSI food types. CONCLUSION Our predictive model categorizes patients with brain insults into risk groups for swallowing disorders, enabling advanced interventions such as percutaneous endoscopic gastrostomy for high-risk patients struggling with NGT removal, while follow-up assessments using FOIS and IDDSI aid in guiding rehabilitation decisions for those at moderate risk.
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Affiliation(s)
- Shih-Ting Huang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei City, Taiwan (R.O.C.)
| | - Mei-Chih Peng
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Wan-Ming Chen
- Big Data Center, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - An-Tzu Jao
- Big Data Center, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Fuk Tan Tang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Yu-Ting Hsieh
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Chun Sheng Ho
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Shu-Ming Yeh
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
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Mazzorana DI, Arif K, Huang J. Gastrostomy Exchange With Displacement Into the Jejunum. Cureus 2024; 16:e57444. [PMID: 38699118 PMCID: PMC11064739 DOI: 10.7759/cureus.57444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
A 54-year-old female with a gastrostomy tube presented with persistent nausea, vomiting, and abdominal pain. On physical examination, the gastrostomy tube was completely advanced into the abdominal cavity with only the external retention ring and hub on the exterior. The first step in the workup was obtaining a scout radiograph. This imaging was appropriate to show the location of the gastrostomy catheter which was overlying the left upper quadrant. The distal tip was heading in the direction of the left lower quadrant. The course of the gastrostomy catheter did not follow the expected direction of the duodenal C-loop. Proceeding forward, contrast was injected through the existing catheter which showed opacification of the jejunal bowel loops. The patient could now be properly diagnosed with gastroenteric intussusception and proper measures could be taken. Following the injected contrast showing jejunal opacification, a stiff Glidewire was advanced through the existing catheter all the way into the jejunum. Deflation of the balloon and removal of the catheter caused an almost instantaneous change in the course of the Glidewire to the more conventional path following the course of the duodenal C-loop. A sheath was then advanced over the wire which was now shown crossing the midline in the proper gastroduodenojejunal course. The final step was to advance a new 22-French MIC gastrostomy catheter over the Glidewire. The contrast was then injected to demonstrate proper opacification of the rugal folds and gastric fundus. The patient reported an immediate resolution of symptoms and was later discharged.
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Affiliation(s)
| | - Kamil Arif
- Interventional Radiology, University of Alabama at Birmingham, Birmingham, USA
| | - Junjian Huang
- Interventional Radiology, University of Alabama at Birmingham, Birmingham, USA
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Skogar ML, Sundbom M. Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades. World J Gastroenterol 2024; 30:1358-1367. [PMID: 38596497 PMCID: PMC11000080 DOI: 10.3748/wjg.v30.i10.1358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/27/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children, respectively, requiring long-term enteral nutrition support. Procedure-related mortality is a rare event, often reported to be zero in smaller studies. National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature. AIM To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term (< 30 d) and long-term survival. METHODS In this retrospective, population-based cohort study, individuals that had received a gastrostomy between 1998-2019 in Sweden were included. Individuals were identified in the Swedish National Patient Register, and survival analysis was possible by cross-referencing the Swedish Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). Kaplan-Meier with log-rank test and Cox regression were used for survival analysis. RESULTS In total 48682 individuals (52% males, average age 60.9 ± 25.3 years) were identified. The cohort consisted of 12.0% children, 29.5% adults, and 58.5% elderly. An increased use of gastrostomies was observed during the study period, from 13.7/100000 to 22.3/100000 individuals (P < 0.001). The use of PEG more than doubled (about 800 to 1800/year), with a corresponding decrease in open gastrostomy (about 700 to 340/year). Laparoscopic gastrostomy increased more than ten-fold (about 20 to 240/year). Overall, PEG, open gastrostomy, and laparoscopic gastrostomy constituted 70.0% (n = 34060), 23.3% (n = 11336), and 4.9% (n = 2404), respectively. Procedure-related mortality was 0.1% (n = 44) overall (PEG: 0.05%, open: 0.24%, laparoscopic: 0.04%). The overall 30-d mortality rate was 10.0% (PEG: 9.8%, open: 12.4%, laparoscopic: 1.7%) and decreased from 11.6% in 1998-2009 vs 8.5% in 2010-2019 (P < 0.001). One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases. CONCLUSION The annual use of gastrostomies in Sweden increased during the study period, with a shift towards more minimally invasive procedures. Although procedure-related death was rare, the overall 30-d mortality rate was high (10%). To overcome this, we believe that patient selection should be improved.
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Affiliation(s)
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden
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Park JW, Kim TG, Cho KB, Kim JS, Cho JW, Jeon JW, Lim SG, Kim CG, Park HJ, Kim TJ, Kim ES, Jeong SJ, Kwon YH. A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions. Gut Liver 2024; 18:77-84. [PMID: 38013476 PMCID: PMC10791510 DOI: 10.5009/gnl230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/29/2023] Open
Abstract
Background/Aims : This study aimed to review the indications, methods, cooperation, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG). Methods : Questionnaires were sent to 200 hospitals, of which 62 returned their questionnaires, with a response rate of approximately 30%. Descriptive statistics were calculated to analyze the responses to the questionnaires. Results : In 2019, a total of 1,052 PEGs were performed in 1,017 patients at 62 hospitals. The main group who underwent PEG was older adult patients with brain disease, particularly stroke. Nutritional supply was an important purpose of the PEG procedure. "The pull method" was the most commonly used for initial PEG insertion. The complications related to PEG were mostly mild, with leakage being the most common. Patients who underwent PEG procedures were primarily educated regarding the post-procedure management and complications related to PEG. Preoperative meetings were skipped at >50% of the institutions. Regarding the cooperation between the nutrition support team (NST) and the physician performing PEG, few endoscopists answered that they cooperated with NST before and after PEG. Moreover, the rate of NST certification obtained by physicians performing PEG and the frequency of attendance at NST-related conferences were relatively low. Conclusions : This study shows a similar trend to that found in the previous PEG guidelines. However, it covers new aspects, including team-based work for PEG procedure, nutrition support, and education for patients and guardians. Therefore, each medical institution needs to select an appropriate method considering the medical environment and doctor's abilities.
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Affiliation(s)
- Jun Woo Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Tae Gyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong Seok Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jung Won Jeon
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hong Jun Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Jun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sun Kim
- Department of Gastroenterology, Korea University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Department of Pediatric Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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11
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Schweckendiek D, Pauli D, Scharl M. [Eating disorders - what the gastroenterologist needs to know]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1484-1493. [PMID: 37156504 DOI: 10.1055/a-2010-3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Eating disorders are potentially life-threatening disorders that go along with severe psychiatric and somatic comorbidities. It is expected that the number of patients will dramatically increase in the post COVID-19 pandemic era.Four main eating disorders are mentioned in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) and the International Classification of Diseases 11 (ICD-11): anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) und avoidant restrictive food intake disorder (ARFID). Many traditional assumptions in eating disorders are currently challenged due to recent research results. The gastroenterologist is usually not the first point of contact for patients with eating disorders. However, he is crucial, especially in the management of gastroenterologic complications of eating disorders.Focus of the overview will be on relevant gastroenterologic aspects and less on the psychiatric treatment. Basics of the most common eating disorders will be repeated, opportunities in diagnosing an eating disorder and the most relevant gastroenterologic complications will be described. Obesity and its management, an entity that often goes along with an eating disorder, is not in the spotlight of the review.
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Affiliation(s)
| | - Dagmar Pauli
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Psychiatrische Universitatsklinik Zürich, Zürich, Schweiz
| | - Michael Scharl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
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12
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Stavrou G, Gionga P, Chatziantoniou G, Tzikos G, Menni A, Panidis S, Shrewsbury A, Kotzampassi K. How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication? World J Gastrointest Surg 2023; 15:940-952. [PMID: 37342839 PMCID: PMC10277955 DOI: 10.4240/wjgs.v15.i5.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is a well-established, minimally invasive, and easy to perform procedure for nutrition delivery, applied to individuals unable to swallow for various reasons. PEG has a high technical success rate of insertion between 95% and 100% in experienced hands, but varying complication rates ranging from 0.4% to 22.5% of cases. AIM To discuss the existing evidence of major procedural complications in PEG, mainly focusing on those that could probably have been avoided, had the endoscopist been more experienced, or less self-confident in relation to the basic safety rules for PEG performance. METHODS After a thorough research of the international literature of a period of more than 30 years of published "case reports" concerning such complications, we critically analyzed only those complications which were considered - after assessment by two experts in PEG performance working separately - to be directly related to a form of malpractice by the endoscopist. RESULTS Malpractice by the endoscopist were considered cases of: Gastrostomy tubes passed through the colon or though the left lateral liver lobe, bleeding after puncture injury of large vessels of the stomach or the peritoneum, peritonitis after viscera damage, and injuries of the esophagus, spleen, and pancreas. CONCLUSION For a safe PEG insertion, the overfilling of the stomach and small bowel with air should be avoided, the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and finally, the physician should be more alert with obese patients and those with previous abdominal surgery.
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Affiliation(s)
- George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
- Department of Surgery, Addenbrooke's Hospital, Cambridge CB22QQ, United Kingdom
| | - Persefoni Gionga
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - George Chatziantoniou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Georgios Tzikos
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Alexandra Menni
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Stavros Panidis
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Anne Shrewsbury
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
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13
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Blanco Ramos B, Gómez Bellvert N. [Caregiver burden and reported quality of life in neurological patients with gastrostomy tubes.]. NUTR HOSP 2023. [PMID: 37154027 DOI: 10.20960/nh.04546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE the aim of the study is to determine if the use of home enteral nutrition (HEN) by percutaneous endoscopic gastrostomy (PEG) reduces the burden on the caregiver and improves the patients' quality of life reported by the caregivers. MATERIAL AND METHODS a prospective, cross-sectional, descriptive, and observational study of a single cohort of 30 patients was conducted. RESULTS the results showed an improvement in nutritional status and analytical parameters. Fewer admissions (1.50 ± 0.90 vs 0.17 ± 0.38; p < 0.001) and hospital stays were reported at 3 months after gastrostomy (10.2 ± 8.02 days vs 0.27 ± 0.69 days; p < 0.001). The minutes spent by caregivers administering NEDs decreased after PEG placement by 28.5 minutes per feeding, which amounts to almost 150 minutes over a day and 5 feedings per day. In the Zarit questionnaire, there was a reduction of 13.5 points in the perception of overload. A total of 56.6 % of caregivers reported that quality of life had improved "quite a lot", compared to 6.7 % who reported little improvement, and 36.7 % who reported a lot of improvement. In the QoL-AD questionnaire, a higher score of 3.40 points was obtained. CONCLUSION the use of HEN by PEG tube reduces the time spent by the caregiver administering EN, which results in a reduced burden. In addition, the quality of life of patients reported by caregivers improved.
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Ikenaga Y, Fudeya M, Kusunoki T, Yamaguchi H. Factors Contributing to Complete Oral Intake in Dysphagic Stroke Patients with Enteral Feeding Tubes in Convalescent Rehabilitation Wards. Prog Rehabil Med 2023; 8:20230011. [PMID: 37006382 PMCID: PMC10061229 DOI: 10.2490/prm.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: This study investigated the factors contributing to complete oral intake (COI) in dysphagic stroke patients with enteral feeding tubes in the local clinical setting. Methods: Data of patients with percutaneous endoscopic gastrostomy (PEG) or nasogastric tube (NGT) feeding on admission to convalescent rehabilitation wards (CRWs) were extracted from the Kaga Regional Cooperation Clinical Pathway for Stroke database for multiple centers including 19 acute care hospitals and 11 hospitals with CRWs. Patients were divided into two groups based on their status regarding COI or incomplete oral intake (ICOI) at discharge. Logistic regression analysis with forced-entry variables was used to identify factors contributing to COI. Results: On discharge from CRWs, COI and ICOI were observed in 140 and 207 cases, respectively. The COI group was younger, had a higher rate of initial stroke, higher Functional Oral Intake Scale (FOIS) scores, higher Functional Independence Measure (FIM) motor and cognitive scores, higher Body Mass Index (BMI), lower rate of patients with PEG, and shorter stays in acute care wards. Logistic regression analysis with forced entry revealed that younger age; initial stroke; higher FOIS score, FIM cognitive score, and BMI; and shorter stay in the acute care ward contributed to COI. Conclusions: The primary factors contributing to COI in dysphagic stroke patients with enteral feeding tubes were younger age, initial stroke, higher swallowing and cognitive function, good nutritional status, and shorter stay in the acute care ward.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | - Masami Fudeya
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | | | - Hiromi Yamaguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
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15
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Yao CC, Liu C, Xian J. Comparison of single-pore non-liposuction near-infrared laparoscopy with conventional open surgery for axillary sentinel lymph node biopsy in patients with early breast cancer: a single-center, small-sample retrospective study. World J Surg Oncol 2023; 21:66. [PMID: 36849976 PMCID: PMC9972847 DOI: 10.1186/s12957-023-02942-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/11/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND This study aimed to compare the effects of single-pore non-liposuction near-infrared (NIR) endoscopic surgery and traditional open surgery for axillary sentinel lymph node biopsy (SLNB) in patients with early breast cancer (EBC). METHODS The clinical pathological data of 61 patients with EBC who underwent axillary SLNB using indocyanine green (ICG) combined with carbon nanoparticle suspension (CNS) were retrospectively collected. Thirty patients received SLNB through single-pore non-liposuction NIR endoscopic surgery (endoscopic group), and the remaining 31 received SLNB through open-incision surgery (open group). The success rate, operation time, volume of intraoperative bleeding, postoperative axillary drainage, axillary extubation time, and the occurrence of postoperative complications were compared between the groups along with the total number of sentinel lymph nodes (SLNs), luminous SLNs, stained SLNs, and the pathological positivity rate of the SLNs. RESULTS All patients underwent SLNB with a 100% success rate. SLNB operation times of the endoscopic group were longer than those of the open group (t = 3.963, P = 0.000), and the volume of axillary drainage was inferior (t = 3.035, P = 0.004). However, there were no differences in the intraoperative bleeding volumes, axillary extubation times, and postoperative complications (P > 0.05). In the Open group, the mean number of SLNs was 5.12 ± 2.16, and the pathological positivity rate was 13.53%; in the Endoscopic group, these numbers were 4.89 ± 1.73 and 12.39%. The mean number of SLNs detected (t = 0.458, P = 0.649) and the pathological positivity rates (χ2 = 0.058, P = 0.810) did not differ between the two groups. All 61 patients were followed for a median of 14.6 months. There were no local recurrences or distant metastases. CONCLUSIONS Our single-center results reveal that single-hole non-liposuction NIR endoscopic axillary SLNB is not inferior to open SLNB and may be an appropriate option for patients with early breast cancer who desire breast preservation with fewer incisions. TRIAL REGISTRATION This retrospective study was "retrospectively registered" at the Sixth Affiliated Hospital of South China University of Technology (no. 2020105) and in National Medical Research Registration and Archival Information System ( https://www.medicalresearch.org.cn , number: MR-44-21-004727).
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Affiliation(s)
- Cheng-cai Yao
- grid.79703.3a0000 0004 1764 3838Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, Foshan, 528225 People’s Republic of China
| | - Changchun Liu
- grid.79703.3a0000 0004 1764 3838Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, Foshan, 528225 People’s Republic of China
| | - Jiayi Xian
- grid.79703.3a0000 0004 1764 3838Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, Foshan, 528225 People’s Republic of China
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Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy. Life (Basel) 2023; 13:life13020473. [PMID: 36836830 PMCID: PMC9962362 DOI: 10.3390/life13020473] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
The number and complexity of endoscopic gastrointestinal diagnostic and therapeutic procedures is globally increasing. Procedural analgosedation during gastrointestinal endoscopic procedures has become the gold standard of gastrointestinal endoscopies. Patient satisfaction and safety are important for the quality of the technique. Currently there are no uniform sedation guidelines and protocols for specific gastrointestinal endoscopic procedures, and there are several challenges surrounding the choice of an appropriate analgosedation technique. These include categories of patients, choice of drug, appropriate monitoring, and medical staff providing the service. The ideal analgosedation technique should enable the satisfaction of the patient, their maximum safety and, at the same time, cost-effectiveness. Although propofol is the gold standard and the most used general anesthetic for endoscopies, its use is not without risks such as pain at the injection site, respiratory depression, and hypotension. New studies are looking for alternatives to propofol, and drugs like remimazolam and ciprofol are in the focus of researchers' interest. New monitoring techniques are also associated with them. The optimal technique of analgosedation should provide good analgesia and sedation, fast recovery, comfort for the endoscopist, patients' safety, and will have financial benefits. The future will show whether these new drugs have succeeded in these goals.
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Hsu CY, Lai JN, Kung WM, Hung CH, Yip HT, Chang YC, Wei CY. Nationwide Prevalence and Outcomes of Long-Term Nasogastric Tube Placement in Adults. Nutrients 2022; 14:nu14091748. [PMID: 35565713 PMCID: PMC9102306 DOI: 10.3390/nu14091748] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023] Open
Abstract
Tube feeding (TF) is commonly used for patients with severe swallowing disturbance, and patients with chronic dysphagia are often provided with a long-term nasogastric tube (NGT). However, nationwide epidemiological data on long-term NGT placement are limited. The present study identified the prevalence and outcomes of patients with long-term NGT placement in Taiwan. Data were obtained from the Longitudinal Health Insurance Database. Patients with NGT placement for more than 3 months between 2000 and 2012 were enrolled in this cohort study. An NGT cohort of 2754 patients was compared with 11,016 controls matched for age, sex, residential area, and comorbidities. The prevalence rate of long-term NGT reached 0.063% in 2005 and then remained stable at 0.05-0.06%. The major causes of NGT placement were stroke (44%), cancer (16%), head injury (14%), and dementia (12%). Men (63%) were more likely to have long-term NGT placement than women (37%). The adjusted hazard ratios were 28.1 (95% CI = 26.0, 30.3) for acute and chronic respiratory infections; 26.8 (95% CI = 24.1, 29.8) for pneumonia, 8.84 (95% CI = 7.87, 9.93) for diseases of the esophagus, stomach, and duodenum; and 7.5 (95% CI = 14.7, 20.8) for mortality. Patients with NGT placement for more than 6 months had a higher odds ratio (1.58, 95% CI = 1.13, 2.20) of pneumonia than those with NGT placement for less than 6 months. Only 13% and 0.62% of the patients underwent rehabilitation therapy and percutaneous endoscopic gastrostomy, respectively. Long-term NGT use was associated with a higher risk of comorbidities and mortality. Stroke was the main illness contributing to long-term NGT use. Further interventions are necessary to improve the negative effects of long-term TF.
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Affiliation(s)
- Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan;
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan;
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan;
| | - Chao-Hsien Hung
- Department of Neurology, Feng Yuan Hospital, Taichung 42055, Taiwan;
| | - Hei-Tung Yip
- Management Office for Health Data, Clinical Trial Center, China Medical University Hospital, Taichung 40447, Taiwan;
- College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yu-Chen Chang
- Show Chwan International Dementia and Movement Disorder Center, Chang Bing Show Chwan Memorial Hospital, Changhua County 50544, Taiwan;
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan;
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County 50544, Taiwan
- Correspondence: ; Tel.: +886-04-7813888
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18
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Li X, Wang JX, Wang YP, Shen JX, Zheng YX, Zhang PH, Wei JJ, Zhuang ZH. Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy. J Multidiscip Healthc 2022; 15:733-741. [PMID: 35411150 PMCID: PMC8994609 DOI: 10.2147/jmdh.s356865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To compare indications, success rates and complications of pull [P] and introducer [I] techniques for percutaneous endoscopic gastrostomy (PEG). Methods In this retrospective study, inpatients who underwent primary PEG tube insertion between January 2015 and February 2020 at the Endoscopy Center of the First Affiliated Hospital of Fujian Medical University were included. Results A total of 103 inpatients were included in this study (P group, n = 67; I group, n = 36). The rates of tube replacement within first six months in the P and I groups were 1.5% and 11.1%, respectively (P = 0.049). The most common primary indication of PEG was malignancy. The proportion of patients with esophageal cancer was significantly lower in the P group (24.4% vs 54.2%, P = 0.015). No significant difference was found in the overall, major, or minor complications between the two groups. In patients with esophageal stenosis, the pull method was a risk factor for complications (P = 0.03; odds ratio [OR] = 12, 95% confidence interval [CI]: 1.164–123.684). Logistic regression analysis showed that the risk factors for major and minor complications were the admission-to-gastrostomy interval (OR = 1.078, 95% CI: 1.016–1.145, P = 0.014) and lack of antibiotic use (OR = 4.735, 95% CI: 1.247–17.979, P = 0.022), respectively. Conclusion Both PEG techniques have high clinical success rates. The introducer technique is more suitable for patients with esophageal stricture, which has lower minor complications, but higher rate of tube replacement compared to the pull technique. Use of antibiotics may reduce minor complications following PEG. Early PEG insertion may help to reduce post-PEG major complications.
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Affiliation(s)
- Xia Li
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
- Endoscope Room, Changle District Hospital, Fuzhou, People’s Republic of China
| | - Jun-Xi Wang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yu-Ping Wang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jia-Xin Shen
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yi-Xing Zheng
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Pei-Hong Zhang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jing-Jing Wei
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Ze-Hao Zhuang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
- Correspondence: Ze-Hao Zhuang, Endoscopy Center, First Affiliated Hospital of Fujian Medical University, 20, Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, People’s Republic of China, Tel +860591-87981370, Fax +860591-87981371, Email
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Li B, Zhang T, Zhao J, Li P, Wu Z, Zhao S. Can non-swallowing function assessment predict nasogastric tube removal in patients with poststroke dysphagia? A clinical study. Front Neurol 2022; 13:984707. [PMID: 36938369 PMCID: PMC10014454 DOI: 10.3389/fneur.2022.984707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/03/2022] [Indexed: 03/04/2023] Open
Abstract
Objective This study aimed to predict nasogastric tube (NGT) removal in patients with poststroke dysphagia (PSD) by non-swallowing function assessment. Methods We enrolled 232 eligible patients and performed rehabilitation. The Fugl-Meyer assessment motor (FMM) and National Institute of Health Stroke Scale (NIHSS) scores were used to measure the motor and overall nervous system functions. Predictors for NGT removal in patients with PSD after rehabilitation were analyzed. Results Of the 232 included patients, the NGTs were removed from 78% of them, while 22% were dependent on a feeding tube after 4 weeks of rehabilitation. Compared to the preserved NGT group, older age, a higher rate of intubation or tracheostomy, and more severe baseline functions were found in the NGT removal group. Age [odds ratio (OR) = 0.907; 95% confidence interval (CI): 0.859-0.957; p = 0.000], difference in the FMM score after 4 weeks of rehabilitation (OR = 1.219; 95% CI: 1.145-1.299; p = 0.00), and item 9 of NIHSS (OR = 0.488; 95% CI: 0.252-0.946; p = 0.034) were predictors of NGT removal after rehabilitation. Conclusion We established a predictive model in patients with PSD using a non-swallowing assessment, which enabled us to predict swallowing recovery based on the non-swallowing function.
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Lima DL, Miranda LEC, da Penha MRC, Lima RNCL, Dos Santos DC, Eufrânio MS, Miranda ACG, Pereira LMMB. Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy. JSLS 2021; 25:JSLS.2021.00040. [PMID: 34456551 PMCID: PMC8372986 DOI: 10.4293/jsls.2021.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding. The aim of this study is to investigate the risk factors associated with early mortality after PEG. Methods: It is a retrospective survival analysis in a tertiary-level hospital. We reviewed the medical records of 277 patients with PEG placement. The data were analyzed by the Kaplan-Meier method. Multivariable Cox proportional regression models were also built to test the effects of PEG on mortality. Results: A total of 277 patients who submitted to PEG were studied. One-hundred and sixty (58%) were female, mean age of 73.3 ± 15.7 years. Ninety-three patients (33.6%) had diabetes mellitus and 165 (59.6%) had blood hypertension. The indications for PEG placement were chronic neurologic dysphagia in 247 (89.5%) patients and tumors and other diseases in 29 (10.5%). The 30 days proportional mortality probability rate was 13%. In a multivariate Cox proportional regression model, preoperative ICU hospitalization (HR 1.79, 95% CI 1.36–2.36, P = 0.000) and hemoglobin (HR 0.91, 95% CI 0.85–0.98, P = 0.015) were predictors of early mortality. Conclusion: In patients who had underwent PEG tube insertion for long-term nutrition, anemia and previous ICU admission were predictors of mortality at four weeks. These factors may guide physicians to discourage the indication for PEG.
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Affiliation(s)
- Diego L Lima
- Department of Surgery, Montefiore Medical Center, The Bronx, New York, USA
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Davrieux CF, Palermo M, Cilfone C, Ronchi A, Giménez M. Laparoscopic-Percutaneous Combined Gastrostomy: Initial Experience and Description of a Technique. J Laparoendosc Adv Surg Tech A 2021; 31:1150-1155. [PMID: 34388357 DOI: 10.1089/lap.2021.0431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Gastrostomy is a widely used procedure that aims to obtain access to the stomach. Its purpose may be feeding or gastric decompression. Currently, the most common techniques are endoscopic and radiologic. Sometimes, these accesses are not available due to technical or patient-specific factors. In these cases, laparoscopic and percutaneous approaches combined could be an option. The aim of this study was to describe a laparoscopic-percutaneous combined gastrostomy procedure, feasibility, and complications. Materials and Methods: Retrospective descriptive observational study. All patients underwent laparoscopic-percutaneous combined gastrostomy required for feeding or decompressive gastrostomy. We analyzed variables: demographics, surgical indication, operation time, hospitalization stay, success, and morbidity/mortality associated to the procedure. Results: A total of n = 17 patients were recruited (58.8% women and 41.2% men), with mean age of 53. Regarding the indications of laparoscopic-percutaneous combined gastrostomy, 47% were due to upper gastrointestinal/head and neck tumor, 29.4% stomach location in a retrocostal position, 17.7% colonic interposition, and 5.9% acute gastric dilation of remnant after Roux-en-Y gastric bypass. The mean time of the procedure was 25 minutes, and mean hospitalization stay was 1.2 days. The success of the procedure was 100%. No complications and mortality associated with the procedure were reported. Conclusion: Laparoscopic-percutaneous combined gastrostomy is fast, feasible, safe, and cost effective. It is an option in patients where it is not possible to perform standard minimally invasive approaches.
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Affiliation(s)
- Carlos Federico Davrieux
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,Department of General Surgery, Sanatorio de la Mujer, Rosario, Argentina
| | - Mariano Palermo
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.,Department of Bariatric Surgery, Diagnomed, Buenos Aires, Argentina
| | - Cecilia Cilfone
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,Department of Pediatric Surgery, DAICIM Foundation, Buenos Aires, Argentina
| | - Antonela Ronchi
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
| | - Mariano Giménez
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.,Institut Hospitalo-Universitaire-Strasbourg (IHU-Strasbourg), Strasbourg, France
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