Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 940-952
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.940
How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication?
George Stavrou, Persefoni Gionga, George Chatziantoniou, Georgios Tzikos, Alexandra Menni, Stavros Panidis, Anne Shrewsbury, Katerina Kotzampassi
George Stavrou, Persefoni Gionga, George Chatziantoniou, Georgios Tzikos, Alexandra Menni, Stavros Panidis, Anne Shrewsbury, Katerina Kotzampassi, Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
George Stavrou, Department of Surgery, Addenbrooke's Hospital, Cambridge CB22QQ, United Kingdom
Author contributions: Gionga P, Menni A and Panidis S performed the initial literature review; Stavrou G and Tzikos G drafted the manuscript; Shrewsbury A and Kotzampassi K performed a critical revision of the manuscript; Shrewsbury A performed language editing; Kotzampassi K received the final decision for inclusion and conceived the original idea; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Katerina Kotzampassi, MD, PhD, Senior Scientist, Surgeon, Department of Surgery, Aristotle University of Thessaloniki, University Campus, Thessaloniki 54636, Greece. kakothe@yahoo.com
Received: December 21, 2022
Peer-review started: December 21, 2022
First decision: January 17, 2023
Revised: January 28, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 27, 2023
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.

Keywords: Percutaneous endoscopic gastrostomy, Complications, Doctor responsibility

Core Tip: For a safe percutaneous endoscopic gastrostomy insertion, the physician should avoid overfilling the stomach and small bowel with air, check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall, ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and be more alert with obese patients and those with previous abdominal surgery.