Download PDF
Zentralbl Chir 2016; 141(04): 442-445
DOI: 10.1055/s-0035-1557765
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Komplikationen nach Anlage einer perkutanen endoskopischen Gastrostomie – eine retrospektive Analyse

Complications after Percutaneous Endoscopic Gastrostomy Tube Placement – A Retrospective Analysis
A. Jafari
1   Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
,
T. J. Weismüller
2   Medizinische Klinik und Poliklinik I – Allgemeine Innere Medizin, Universitätsklinikum Bonn, Deutschland
,
T. Tonguc
1   Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
,
J. C. Kalff
1   Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
,
S. Manekeller
1   Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
10 August 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Bei Patienten mit maligner Grunderkrankung oder benignen Schluck- und Passagestörungen ist eine physiologische, enterale Ernährung die Basis zur Vermeidung kataboler Stoffwechselvorgänge. Hier hat sich die Anlage einer perkutanen endoskopischen Gastrostomie (PEG) bewährt. Deren Überlegenheit gegenüber anderen Verfahren konnte in klinischen Studien wiederholt nachgewiesen werden. Trotz geringer Invasivität weist die Anlage einer PEG jedoch eine nicht unerhebliche Komplikationsrate auf. Patienten und Methoden: Es wurde eine retrospektive Analyse der PEG-Anlagen zwischen Januar 2005 und Dezember 2012 im Universitätsklinikum Bonn durchgeführt. Ergebnisse: Bei insgesamt 641 PEG-Anlagen lag die Gesamtkomplikationsrate bei 9,4 %. Davon waren 5,5 % Minorkomplikationen (MiK) und 3,9 % Majorkomplikationen (MaK). Zwei Patienten sind verstorben. Endoskopisch lag die Komplikationsrate bei 8,5 % (4,8 % MiK, 3,8 % MaK). Die MaK waren zu 63,2 % Perforationen, zu 15,8 % intraabdominelle Abszesse und zu 15,8 % ein Buried-Bumper-Syndrom. Die CT-gesteuerte PEG-Anlage ergab eine Komplikationsrate von 38,9 % (27,8 % MiK und 11,1 % MaK). Die MaK waren allesamt Hohlorganperforationen. Bei der offen-chirurgischen Methode konnte eine MiK von 7,7 % nachgewiesen werden. Hier gab es keine MaK. Schlussfolgerung: Auch in unserem Patientenkollektiv zeigte sich eine beachtliche Komplikationsrate. Daher sollte die Indikation kritisch hinterfragt und die Implantationstechnik im Konsens festgelegt werden. Unabdingbar für eine geringe MiK sind eine ausgezeichnete Nachbetreuung sowie die Schulung des Ärzte- und Pflegepersonals und genaueste Pflegeanweisungen für die Angehörigen und den ambulanten Pflegedienst.

Abstract

Background: Enteral nutrition is vital for patients with inadequate or absent oral food intake, as it can help to avoid catabolic metabolism. Enteral feeding can be secured by placing a percutaneous endoscopic gastrostomy tube (PEG-tube) which is an approved method. Several clinical studies could verify the superiority of this procedure compared to other options. Even though PEG-tube placement is regarded as less invasive surgery, a considerable rate of complications is reported in literature. Material/Methods: Here, we report a retrospective analysis of PEG-tube placements in the Bonn University Hospital from January 2005 to December 2012. Results: Overall, 641 PEG-tubes were placed with a complication rate of 9.4 %, which can be further divided in 5.5 % minor complications (mic) and 3.9 % major complications (mac). Two cases of death occurred in the context of PEG-tube placement. Endoscopically inserted PEG-tubes showed a complication rate of 8.6 % (4.8 % mic, 3.8 % mac). 63.2 % of mac consisted of perforations, 15.8 % of intra-abdominal abscesses and 15.8 % of buried bumper syndromes. The complication rate of CT-guided placement of PEG-tubes was 38.9 % (27.8 % mic, 11.1 % mac). In this group, all mac were perforations. Surgical PEG-tube placement was accompanied by no mac and 7.7 % mic. Conclusion: The amount of complications during PEG-tube placement is remarkable, therefore the indication of this procedure must be contemplated critically and careful follow-up is crucial.

Schlüsselwörter

perkutane endoskopische Gastrostomie - Komplikationsrate - enterale Ernährung

Key words

percutaneous endoscopic gastrostomy tube - complication rate - enteral nutrition
 

  • Literatur

  • 1 Chandu A, Smith AC, Douglas M. Percutaneous endoscopic gastrostomy in patients undergoing resection of oral tumors: a retrospective review of complications and outcomes. J Oral Maxillofac Surg 2003; 61: 1279-1284
    CrossrefPubMedGoogle Scholar
  • 2 Blomberg J, Lagergren J, Martin L et al. Complications after percutaneous endoscopic gastrostomy in a retrospective study. Scand J Gastroenterol 2012; 47: 737-742
    CrossrefPubMedGoogle Scholar
  • 3 Grant JP. Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg 1988; 207: 598-603
    CrossrefPubMedGoogle Scholar
  • 4 Ho CS, Yee AC, McPherson R. Complications of surgical and percutaneous nonendoscopic gastrostomy: review of 233 patients. Gastroenterology 1988; 95: 1206-1210
    CrossrefPubMedGoogle Scholar
  • 5 Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endosc 2006; 20: 1248-1251
    CrossrefPubMedGoogle Scholar
  • 6 Merkhail TM, Adelstein DJ, Rybicki LA et al. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube?. Cancer 2001; 91: 1785-1790
    CrossrefPubMedGoogle Scholar
  • 7 Norton B, Homer-Ward M, Donnelly MT et al. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic strike. BMJ 1996; 312: 13-16
    CrossrefPubMedGoogle Scholar
  • 8 Lozoya-Gonzalez D, Pelaez-Luna M, Farca-Belsaguy A et al. Percutaneous endoscopic gastrostomy complication rates and compliance with the American Society for Gastrointestinal Endoscopy guidelines for the management of antithrombotic therapy. JPEN J Parenter Enteral Nutr 2012; 36: 226-230
    CrossrefPubMedGoogle Scholar
  • 9 Smith BM, Perring P, Engoren M et al. Hospital and long-term outcome after percutaneous endoscopic gastrostomy. Surg Endosc 2008; 22: 74-80
    CrossrefPubMedGoogle Scholar
  • 10 Tessier W, Piessen G, Briez N et al. Percutaneous radiological gastrostomy in esophageal cancer patients: a feasible and safe access for nutritional support during multimodal therapy. Surg Endosc 2013; 27: 633-641
    CrossrefPubMedGoogle Scholar
  • 11 Meenaghan N, Lumpkins K, Scott Roth J. Percutaneous endoscopic gastrostomy tube placement is safe in patients undergoing corticosteroid therapy. J Gastrointest Surg 2009; 13: 236-238
    CrossrefPubMedGoogle Scholar
  • 12 Kim JS, Park YW, Cho YS et al. Is percutaneous endoscopic gastrostomy tube placement safe in patients with ventriculoperitoneal shunts?. World J Gastroenterol 2009; 15: 3148-3152
    CrossrefPubMedGoogle Scholar
  • 13 Cosentini EP, Sautner T, Gnant M et al. Outcomes of surgical percutaneous endoscopic and percutaneous radiologic gastrostomies. Arch Surg 1998; 133: 1076-1083
    CrossrefPubMedGoogle Scholar
  • 14 Moller P, Lindberg CG, Zilling T. Gastrostomy by various techniques: evaluation of indications, outcome and complications. Scand J Gastroenterol 1999; 10: 1050-1054
    PubMedGoogle Scholar
  • 15 Silas AM, Pearce LF, Lestina LS et al. Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: a comparison of indications, complications and outcomes in 370 patients. Eur J Radiol 2005; 56: 84-90
    CrossrefPubMedGoogle Scholar
  • 16 Grant DG, Bradley PT, Pothier DD et al. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 2009; 34: 103-112
    CrossrefPubMedGoogle Scholar
  • 17 Birgisson S. Percutaneous endoscopic gastrostomy in Iceland over 10 year period: a retrospective study of indications, complications and ethical issues. Laeknabladid 2012; 98: 97-102
    PubMedGoogle Scholar
  • 18 Fagundes RB, Cantarelli jr. JC, Fontana K et al. Percutaneous endoscopic gastrostomy and peristomal infection: an avoidable complication with the use of a minimum skin incision. Surg Laparosc Endosc Percutan Tech 2011; 21: 275-277
    CrossrefPubMedGoogle Scholar
  • 19 Walton GM. Complications of percutaneous gastrostomy in patients with head and neck cancer – an analysis of 42 consecutive patients. Ann R Coll Surg Engl 1999; 81: 272-276
    PubMedGoogle Scholar
  • 20 Lee C, Im JP, Kim SE et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy: a multicenter, retrospective study. Surg Endosc 2013; 27: 3806-3815
    CrossrefPubMedGoogle Scholar
  • 21 Hujala K, Sipila J, Pulkkinen J et al. Early percutaneous endoscopic gastrostomy nutrition in head and neck cancer patients. Acta Otolaryngol 2004; 124: 847-850
    CrossrefPubMedGoogle Scholar
  • 22 Jafri NS, Mahid SS, Minor KS et al. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther 2007; 25: 647-656
    Google Scholar
  • 23 Yarmus L, Gilbert C, Lechtzin M et al. The safety and feasibility of interventional pulmonologists performing bedside percutaneous endoscopic gastrostomy tube placement. Chest 2013; 144: 436-440
    CrossrefPubMedGoogle Scholar
  • 24 OʼMahony S. Difficulties with percutaneous endoscopic gastrostomy (PEG): a practical guide for the endoscopist. Ir J Med Sci 2013; 182: 25-28
    CrossrefPubMedGoogle Scholar
  • 25 Wilhelm SM, Ortega KA, Stellato TA. Guidelines for identification and management of outpatient percutaneous endoscopic gastrostomy tube placement. Am J Surg 2010; 199: 396-399
    CrossrefPubMedGoogle Scholar
  • 26 Shastri YM, Hoepffner N, Tessmer A et al. New introducer PEG gastropexy does not require prophylactic antibiotics: multicenter prospective randomized double-blind placebo-controlled study. Gastrointest Endosc 2008; 67: 620-628
    CrossrefPubMedGoogle Scholar
  • 27 Hermanowicz A, Matuszcak E, Komarowska M et al. Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutrition even in patients with distorted anatomy. World J Gastroenterol 2013; 19: 7696-7700
    CrossrefPubMedGoogle Scholar
  • 28 Shimizu Y, Okuyama H, Sasaki T et al. Laparoscopic-assisted percutaneous endoscopic gastrostomy: a simple and efficient technique for disabled elderly patients. JPEN J Parenter Enteral Nutr 2014; 38: 475-480
    CrossrefPubMedGoogle Scholar
  • 29 Wragg RC, Salminen H, Pachl M et al. Gastrostomy insertion in the 21st century: PEG or laparoscopic? Report from a large single-centre series. Pediatr Surg Int 2012; 28: 443-444
    CrossrefPubMedGoogle Scholar