Feasibility and Safety of Percutaneous Endoscopic Gastrostomy in Patients with Subtotal Gastrectomy

Background and Study Aims: We aimed to study the technical feasibility, safety, efficacy and complications of endoscopic feeding tube placement in patients who had previously undergone subtotal gastrectomy. We also investigated whether jejunal feeding tube placement (percutaneous endoscopic jejunostomy [PEJ]) is superior to gastric feeding tube placement (percutaneous endoscopic gastrostomy [PEG]) in the prevention of aspiration pneumonia in patients with subtotal gastrectomy.
Patients and Methods: A retrospective cohort study was carried out which included 48 patients treated between 1995 and 2001. Participants were selected from 3400 patients who were referred for PEG placement. The study group consisted of 15 consecutive patients with a prior subtotal gastrectomy. The control group comprised 33 randomly selected patients with intact stomachs. The primary end point of the study concerned the safety of PEG placement. The secondary end points included the efficacy and technical difficulty of the procedure.

Results: PEG/PEJ placement was successful in 14 of the 15 patients (93 %) who had previously had a subtotal gastrectomy. None of the study patients developed procedure-related complications. Feeding intolerance was more common in patients with gastrectomy compared with patients with an intact stomach, but the difference did not reach statistical significance (10 % vs. 3 %, P > 0.05). A significantly higher incidence of pneumonia was observed in patients with gastrectomy compared with patients with an intact stomach (P = 0.01). Subgroup analysis showed that the risk was higher with jejunal tube placement compared with gastric tube placement (42 % vs. 12 %, P = 0.001).
Conclusion: PEG/PEJ placement in patients with gastrectomy is a technically safe procedure. These patients are at higher risk of aspiration pneumonia and risk is higher with jejunal tube placement compared with gastric tube placement.

References

• 1 Shapiro G D, Edmundowicz S A. Complications of percutaneous endoscopic gastrostomy.  Gastrointest Endosc Clin N Am. 1996;  6 409-422
• 2 Swetech J, Hasan S. Combined endoscopic and surgical modalities for percutaneous endoscopic gastrostomy placement in the setting of subtotal gastrectomy with a gastric pull up.  Gastrointest Endosc. 1990;  36 316-317
• 3 Kurchin A, Halloran W, Kornfield R. Assessing the feasibility of percutaneous endoscopic gastrostomy following gastrectomy.  Gastrointest Endosc. 1988;  34 366-367
• 4 Varney R A, van Sonnenberg E, Casola G, Sukthankar R. Balloon techniques for percutaneous gastrostomy in a patient with partial gastrectomy.  Radiology. 1988;  167 69-70
• 5 Stellato T A, Ganderer M WL, Ponsky J L. Percutaneous endoscopic gastrostomy following previous surgery.  Am Surg. 1984;  200 46
• 6 Rosenzweig T B, Palestrant A M, Esplin C A, Gilsdorf R B. A method for radiologic-assisted gastrostomy when percutaneous endoscopic gastrostomy is contraindicated.  Am J Surg. 1994;  168 587-591
• 7 Kanazawa S, Naomoto Y, Hiraki Y, Matsuno T. Percutaneous feeding gastrostomy in patients with a partial gastrectomy: transhepatic approach with CT guidance.  Abdom Imag. 1995;  20 302-306
• 8 Yamazaki T, Sakai Y, Hatakeyma K, Hoshiyama Y. Colocutaneous fistula after percutaneous endoscopic gastrostomy in a remnant stomach.  Surg Endosc. 1999;  13 280-282
• 9 Lazarus B A, Murphy J B, Culpepper L. Aspiration associated with long-term gastric versus jejunal feeding: a critical analysis of literature.  Arch Phys Med Rehabil. 1990;  71 46-53
• 10 Cameron J L, Mitchell W H, Zuidema G D. Aspiration pneumonia: clinical outcome following documented aspiration.  Arch Surg. 1973;  106 49-52
• 11 Fox K A, Mularski R A, Sarfati M R. et al . Aspiration pneumonia following surgically placed feeding tubes.  Am J Surg. 1995;  170 564-567
• 12 DiSario J A, Foutch P G, Sanowski R A. Poor results with percutaneous endoscopic jejunostomy.  Gastrointest Endosc. 1990;  36 257-260