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Endosc Int Open 2016; 04(09): E990-E996
DOI: 10.1055/s-0042-112587
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Percutaneous endoscopic gastrostomy (PEG) using a novel large-caliber introducer technique kit: a retrospective analysis

Ezekiel Wong Toh Yoon
1   Department of Internal Medicine (Gastroenterology), Hiroshima Kyoritsu Hospital, Hiroshima City, Japan
,
Kaori Yoneda
2   Endocopy Center, Hiroshima Kyoritsu Hospital, Hiroshima City, Japan
,
Shinya Nakamura
1   Department of Internal Medicine (Gastroenterology), Hiroshima Kyoritsu Hospital, Hiroshima City, Japan
,
Kazuki Nishihara
1   Department of Internal Medicine (Gastroenterology), Hiroshima Kyoritsu Hospital, Hiroshima City, Japan
› Author Affiliations
Further Information

Publication History

submitted 18 April 2016

accepted after revision 06 July 2016

Publication Date:
30 August 2016 (online)

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Background and study aims: Percutaneous endoscopic gastrostomy (PEG) using the introducer technique is not only useful in patients with upper digestive tract stenosis but has been shown to reduce peristomal infection. In this study, we evaluated the safety and utility of a novel large-caliber introducer PEG kit (using 20 Fr size tube) compared with a push kit of similar size.

Patients and methods: One hundred and thirty-six patients who received PEG at our hospital between January 2014 and December 2015 were retrospectively analyzed. Baseline characteristics, laboratory biomarkers, hemodynamic changes, postoperative adverse events and clinical outcomes with both kits were compared.

Results: The new introducer PEG kit was used in 61 patients while the remaining 75 patients received tube placement using a push technique PEG kit. Except for the prevalence of dementia, which was lower in the introducer PEG kit group, baseline characteristics were similar in both groups. Tube placements were 100 % successful with both PEG kits and there were no significant differences in the change of postoperative hemodynamic or laboratory biomarkers. The Introducer PEG kit group experienced fewer incidence of feeding-related aspiration pneumonia (8.2 % vs. 24 %, P = 0.02), lower peristomal infection scores (1.2 vs. 1.6, P < 0.01), shorter postoperative length of stay (16 days vs. 23.7 days, P = 0.01) and fewer deaths at day 60 (3.3 % vs. 16 %, P = 0.02).

Conclusions: Gastrostomy using the new large-caliber introducer PEG kit is safe and produced non-inferior (with some favourable) results when compared to the push technique using similar size tubes.

 

  • References

  • 1 Gauderer MW, Ponsky JL, Izant Jr RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15: 872-875
    CrossrefPubMedGoogle Scholar
  • 2 DeLegge MH. Percutaneous endoscopic gastrostomy. Am J Gastroenterol 2007; 102: 2620-2623
    CrossrefPubMedGoogle Scholar
  • 3 Suzuki Y, Tamez S, Murakami A et al. Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan. World J Gastroenterol 2010; 16: 5084-5091
    CrossrefPubMedGoogle Scholar
  • 4 Richter-Schrag HJ, Richter S, Ruthmann O et al. Risk factors and complications following percutaneous endoscopic gastrostomy: a case series of 1041 patients. Can J Gastroenterol 2011; 25: 201-206
    CrossrefPubMedGoogle Scholar
  • 5 Gossner L, Keymling J, Hahn EG et al. Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical trial. Endoscopy 1999; 31: 119-124
    Google Scholar
  • 6 Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database Syst Rev 2013; 11: CD005571
    PubMedGoogle Scholar
  • 7 Lee C, Im JP, Kim JW et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy: a multicenter, retrospective study. Surg Endosc 2013; 27: 3806-3815
    CrossrefPubMedGoogle Scholar
  • 8 Wirth R, Bauer J, Sieber C. Necrotizing Candida infection after percutaneous endoscopic gastrostomy: a fatal and rare complication. JPEN J Parenter Enteral Nutr 2008; 32: 285-287
    CrossrefPubMedGoogle Scholar
  • 9 Hashiba K. Technic for opening a gastrostomy under endoscopic control and manipulation. Rev Paul Med 1980; 95: 37-38 [article in portuguese]
    PubMedGoogle Scholar
  • 10 Ueno F, Kadota T. Percutaneous endoscopic gastrostomy- Report of a simplified new technique. Progress of Digestive Endoscopy 1983; 23: 60-62 [article in japanese]
    PubMedGoogle Scholar
  • 11 Russell TR, Brotman M, Norris F. Percutaneous gastrostomy. A new simplified and cost-effective technique. Am J Surg 1984; 148: 132-137
    CrossrefPubMedGoogle Scholar
  • 12 Foster JM, Filocamo P, Nava H et al. The introducer technique is the optimal method for placing percutaneous endoscopic gastrostomy tubes in head and neck cancer patients. Surg Endosc 2007; 21: 897-901
    CrossrefPubMedGoogle Scholar
  • 13 Riley DA, Strauss M. Airway and other complications of percutaneous endoscopic gastrostomy in head and neck cancer patients. Ann Otol Rhinol Laryngol 1992; 101: 310-313
    CrossrefPubMedGoogle Scholar
  • 14 Huang AT, Georgolios A, Espino S et al. Percutaneous endoscopic gastrostomy site metastasis from head and neck squamous cell carcinoma: case series and literature review. J Otolaryngol Head Neck Surg 2013; 42: 20
    CrossrefPubMedGoogle Scholar
  • 15 Maetani I, Tada T, Ukita T et al. PEG with introducer or pull method: a prospective randomized comparison. Gastrointest Endosc 2003; 57: 837-841
    CrossrefPubMedGoogle Scholar
  • 16 Campoli PM, de Paula AA, Alves LG et al. Effect of the introducer technique compared with the pull technique on the peristomal infection rate in PEG: a meta-analysis. Gastrointest Endosc 2012; 75: 988-996
    CrossrefPubMedGoogle Scholar
  • 17 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
  • 18 Loser C, Aschl G, Hébuterne X et al. ESPEN guidelines on artificial enteral nutrition: percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005; 24: 848-861
    CrossrefPubMedGoogle Scholar
  • 19 Lee SW, Lee JH, Cho H et al. Comparison of clinical outcomes associated with pull-type and introducer-type percutaneous endoscopic gastrostomies. Clin Endosc 2014; 47: 530-537
    CrossrefPubMedGoogle Scholar
  • 20 Sacks BA, Vine HS, Palestrant AM et al. A nonoperative technique for establishment of a gastrostomy in the dog. Invest Radiol 1983; 18: 485-487
    CrossrefPubMedGoogle Scholar
  • 21 Jain NK, Larson DE, Schroeder KW et al. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy. A prospective, randomized, double-blind clinical trial. Ann Intern Med 1987; 107: 824-828
    Google Scholar
  • 22 Miller RE, Kummer BA, Tiszenkel HI et al. Percutaneous endoscopic gastrostomy. Procedure of choice. Ann Surg 1986; 204: 543-545
    CrossrefPubMedGoogle Scholar
  • 23 Kozarek RA, Ball TJ, Ryan Jr JA. When push comes to shove: a comparison between two methods of percutaneous endoscopic gastrostomy. Am J Gastroenterol 1986; 81: 642-646
    PubMedGoogle Scholar
  • 24 Hashiba K. Endoscopic gastrostomy. Endoscopy 1987; 19: 23-24
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Dormann AJ, Glosemeyer R, Leistner U et al. Modified percutaneous endoscopic gastrostomy (PEG) with gastropexy--early experience with a new introducer technique. Z Gastroenterol 2000; 38: 933-938
    Google Scholar
  • 26 Martins FP, Sousa MC, Ferrari AP. New “introducer” PEG-gastropexy with T fasteners: a pilot study. Arq Gastroenterol 2011; 48: 231-235
    CrossrefPubMedGoogle Scholar
  • 27 Okumura N, Tsuji N, Ozaki N et al. Percutaneous endoscopic gastrostomy with Funada-style gastropexy greatly reduces the risk of peristomal infection. Gastroenterol Rep (Oxf) 2015; 3: 69-74
    CrossrefPubMedGoogle Scholar
  • 28 Kanie J, Suzuki Y, Iguchi A et al. Prevention of gastroesophageal reflux using an application of half-solid nutrients in patients with percutaneous endoscopic gastrostomy feeding. J Am Geriatr Soc 2004; 52: 466-467
    CrossrefPubMedGoogle Scholar
  • 29 Nishiwaki S, Araki H, Shirakami Y et al. Inhibition of gastroesophageal reflux by semi-solid nutrients in patients with percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr 2009; 33: 513-519
    CrossrefPubMedGoogle Scholar
  • 30 Horiuchi A, Nakayama Y, Tanaka N et al. Prospective randomized trial comparing the direct method using a 24 Fr bumper-button-type device with the pull method for percutaneous endoscopic gastrostomy. Endoscopy 2008; 40: 722-726
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Shigoka H, Maetani I, Tominaga K et al. Comparison of modified introducer method with pull method for percutaneous endoscopic gastrostomy: prospective randomized study. Dig Endosc 2012; 24: 426-431
    CrossrefPubMedGoogle Scholar
  • 32 Giordano-Nappi JH, Maluf-Filho F, Ishioka S et al. A new large-caliber trocar for percutaneous endoscopic gastrostomy by the introducer technique in head and neck cancer patients. Endoscopy 2011; 43: 752-758
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Van Dyck E, Macken EJ, Roth B et al. Safety of pull-type and introducer percutaneous endoscopic gastrostomy tubes in oncology patients: a retrospective analysis. BMC Gastroenterol 2011; 11: 23
    CrossrefPubMedGoogle Scholar