Percutaneous endoscopic gastrostomy (PEG) has been increasingly used in treating patients with neurogenic dysphagia to improve nutrition status and prevent choking. PEG is mostly used for stroke and amyotrophic lateral sclerosis, although more evidence-based researches are required to assess the timing, risks, and survival benefits. Its application in senile dementia is still controversial.
Alzheimer Disease ; surgery ; Amyotrophic Lateral Sclerosis ; surgery ; Enteral Nutrition ; methods ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Humans ; Nervous System Diseases ; surgery

OBJECTIVETo analyze the efficacy of percutaneous endoscopic gastrostomy (PEG) in pediatric patients.

METHODFrom October 2011 to October 2014, children in the gastrointestinal ward of Guangzhou Women and Children's Medical Center received PEG or jejunal tube PEG(JET-PEG). The success rate, operation time were recorded. The changes of their weight, enteral nutrition calories and the incidence of pneumonia before and after the first 6 months of operation were compared. Follow-up was conducted until October 2014, the recent and long term complications, the length of indwelling time, the replacement or removal of the tube were recorded, the patients swallowing function or the primary disease's outcomes were observed.

RESULTOf the 13 cases, 10 were male, 3 were female, their average age was 2 years (range 1.8 months-9 years). We performed PEG for 12 of the patients who had congenital craniofacial problems that led to feeding difficulties or recurrent cough and pneumonia (6/12), or neurological disorders (6/12) with inability to swallow, and in one case JET-PEG was performed, this child suffered from chronic intestinal pseudo-obstruction with vomiting and abdominal distension. The gastrostomy was successful in all the patients through one operation, the average operation time of PEG was (25 ± 3) minutes, JET-PEG was 60 minutes. One local skin infection was noted, no long-term complication occurred. In the first 6 months after operation, all the patients gained weight((5.5-30.5) kg postoperation vs. (3.0-30.0) kg preoperation), and 12 cases' enteral nutrition calories increased (from (209-502) to(272-543) kJ/(kg·d)), the incidence of pneumonia decreased in the children who had recurrent pneumonia before the operation (from (0-1.5) to (0-0.16) per month). Until October 2014, their average length of gastric tube indwelling time was 17.8 months (range 4-36 months). In 4 cases PEG tube was removed when they could eat completely independently, the other 9 needed enteral vein nutrition via PEG tube or jejunal tube, in 3 of them balloon type gastric fistula tube was applied. Two of the 13 cases who had cleft palate received stomatological operations when their weight grew to meet the standard.

CONCLUSIONPEG and JET-PEG are safe and effective method for enteric nutrition feeding in pediatrics, the technique causes minimal trauma and has rapid postoperative recovery, few complications, good aesthetic appearances and simple nursing, it can significantly improve their nutritional status and quality of life.

Child ; Child, Preschool ; Enteral Nutrition ; methods ; Female ; Gastrostomy ; adverse effects ; Humans ; Incidence ; Infant ; Male ; Nervous System Diseases ; therapy ; Pneumonia ; therapy

OBJECTIVETo explore the clinical value of percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) in critically ill patients.

METHODSWe retrospectively analysed the clinical data of 30 critically ill patients who received PEG/J in our hospital. The indications, key operation procedures, peri-operative preparation, complications, and efficacy were recorded.

RESULTSTwenty-nine critically ill patients successfully received PEG/J. The mean operation time of PEG and PEJ were (7.5 +/- 2.5) min and (12.5 +/- 8.2) min, respectively, and the duration of tube functioning was (230 +/- 159) d; no procedure-related complications and serious complications were observed. Complications included local soft tissue infection (n = 1), J-tube dislodgment (n = 1), and obstruction of jejunal tube (n = 2). The serum levels of albumin and pre-albumin increased 4 weeks after operation; however, no significant difference was observed.

CONCLUSIONPEG/J is an effective, micro-invasive, safe, and convenient approach to establish a long-term gastrointestinal nutrition route for critically ill patients.

Aged ; Aged, 80 and over ; Critical Illness ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin ; metabolism

OBJECTIVETo summarize the clinical experiences in percutaneous endoscopic gastrostomy (PEG)/percutaneous endoscopic jejunostomy (PEJ).

METHODSWe retrospectively analyzed the clinical data of 578 patients who received either PEG or PEJ from July 2001 to December 2007 in our hospital. The data analyzed included the type, aim, duration, success rate, and complications of these procedures.

RESULTSOf 578 patients, 247 patients underwent PEG, 293 patients underwent percutaneous endoscopic gastrojejunostomy (PEGJ), 4 patients received percutaneous endoscopic duodenostomy (PED), 4 patients underwent direct percutaneous endoscopic jejunostomy (DPEJ), 4 patients underwent percutaneous endoscopic colostomy (PEC), and 26 patients received PEG/J combined stents. These procedures were performed in different clinical conditions, including enteral nutrition (n = 329), decompression combined enteral nutrition (n = 133), decompression of the gastrointestinal tract (n = 103), enteral nutrition combined bile refeeding (n = 5), perioperative applications (n = 4), and coloclysis (n = 4). Tubes were successfully placed in 578 patients (98.0%) in an average time of (7.5 +/- 1.9) min in PEG, (17.7 +/- 4.2) min in PEGJ, (14.8 +/- 2.1) min in DPEJ, (12.3 +/- 2.5) min in PED, (11.3 +/- 2.6) min in PEC, and (30.2 +/- 5.2) min in PEG/J combined stent, respectively. No procedure-related complications were observed. Major complications were found in 6 patients (1.04%) and minor complications in 36 patients (6.23%). The duration of tube functioning was (168.37 +/- 198.64) d.

CONCLUSIONSPEG/PEJ are easy to handle, effective, safe, and convenient for nursing. The endoscopic method of tube placement can be performed at the bedside and allow for enteral feeding, gastrointestinal decompression, and internal biliary drainage to be rapidly and efficiently achieved.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo explore the clinical significance of improvement gastrostomy in pancreaticoduodenectomy.

METHODSClinical data of 82 patients who underwent pancreaticoduodenectomy and jejunostomy from November 2004 to December 2006 were collected, among which 36 patients received improvement gastrostomy (treatment group), 24 patients accepted traditionary gastrostomy (control group 1) and 22 patients without any gastrostomy (control group 2). Operative time, postoperative duration of gastrointestinal decompression tube, postoperative gastroparesis, pancreatic fistula, biliary fistula, and abdominal cavity infection were compared.

RESULTSThe incidence of postoperative gastroparesis in the treatment group and control group 2 were can significantly lower than that in the control group 1 (P < 0.05). The postoperative duration of gastrointestinal decompression tube of the treatment group was significant shorter than that of control group 2 (P < 0.01). There were no significant difference in other items.

CONCLUSIONSThe improvement gastrostomy in pancreaticoduodenectomy is simple and secure. It can significantly shorten the postoperative duration of gastrointestinal decompression tube and also obviously reduce the incidence of postoperative gastroparesis compared with traditionary gastrostomy.

Adult ; Aged ; Female ; Gastroparesis ; etiology ; prevention & control ; Gastrostomy ; methods ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; adverse effects ; methods ; Postoperative Complications ; etiology ; prevention & control ; Treatment Outcome

OBJECTIVETo evaluate the application value of percutaneous endoscopic gastrostomy (PEG) for home nutrition support in patients with stroke and post-traumatic brain.

METHODSWe retrospectively analyzed the clinical data of the 16 patients with stroke and post-traumatic brain, including cerebral infarction (n = 9), cerebral hemorrhage ( n = 5), subarachnoid hemorrhage (n = 1), and cerebral trauma (n = 1). All these patients underwent PEG in our hospital because they were not able to be orally fed.

RESULTSThe weight, triceps skinfold thickness, mid-upper arm muscle circumference, and serum albumin, hemoglobin, and lympholeukocyte cell counts 30, 60, and 120 days after hospital discharge were significantly higher than those at hospital discharge (P <0.05 or P <0.01). The NIHSS scores 30, 60, and 120 days after hospital discharge were 14.0 +/- 1.3, 14.0 +/- 1.1, and 3.0 +/- 1.2, respectively, which were significantly lower than 16.0 +/- 1.2 at hospital discharge (all P <0.05). Complications included gastric contents retention (n = 1), backstreaming (n = 1), aspirated pneumonia (n = 1), and intra-cushion syndrome (n = 1).

CONCLUSIONSPEG for home nutrition support is useful for the treatment of patients with stroke and post-traumatic brain with dysphagia and malnutrition after long-term coma. It can help to avoid the deterioration of nutritional status and improve the quality of life.

Adult ; Aged ; Aged, 80 and over ; Cerebral Hemorrhage ; physiopathology ; Cerebral Infarction ; physiopathology ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Hemoglobins ; metabolism ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin ; metabolism ; Stroke ; physiopathology ; Subarachnoid Hemorrhage ; physiopathology

OBJECTIVETo evaluate the monolayer wide-edge continuous suture anastomosis in order to explore the method to prevent or reduce the frequency of anastomotic fistula and stenosis.

METHODS936 esophageal cancer patients were divided into two groups: 468 by monolayer wide-edge continuous suture anastomosis with absorbable suture at esophagogastrostomy; while the other 468 by regular interrupted suture anastomosis with silk thread as control. The complication such as anastomotic fistula and stenosis in two groups were compared.

RESULTSIn the group treated by monolayer wide-edge continuous suture anastomosis, there were 1 fistula (0.2%) and 1 stenosis (0.2%) versus 8 fistula (1.9%) and 11 stenosis (2.4%) in the control group. There was a statistically significant difference between two guoups was observed (P < 0.05).

CONCLUSIONMonolayer wide-edge continuous suture anastomosis at esophagogastrostomy for esophageal cancer patient may effectively prevent or reduce the frequency of anastomotic fistula and stenosis.

Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; adverse effects ; methods ; Carcinoma, Squamous Cell ; surgery ; Esophageal Fistula ; etiology ; Esophageal Neoplasms ; surgery ; Esophageal Stenosis ; etiology ; Esophagectomy ; adverse effects ; methods ; Female ; Follow-Up Studies ; Gastrostomy ; adverse effects ; methods ; Humans ; Male ; Middle Aged ; Suture Techniques ; adverse effects

Enteral Nutrition ; instrumentation ; methods ; Female ; Fluoroscopy ; methods ; Gastrostomy ; adverse effects ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications ; classification ; diagnosis ; therapy ; Reproducibility of Results ; Retrospective Studies ; Singapore ; Surgery, Computer-Assisted ; methods ; Treatment Outcome

OBJECTIVE: To observe the clinical results of laminated anastomosis using absorbable suture in cervical esophagogastrostomy, and to reduce the incidence of cervical esophagogastric anastomotic stricture. METHODS: A retrospective analysis was carried out on 210 patients who underwent cervical esophagogastrostomy after subtotal esophagectomy from January 2008 to June 2010. Among them, 96 cases were treated with traditional full layer interrupted varus suture (varus group) and the remaining 114 cases were treated with seromuscular layer and mucosal layer laminated anastomosis with absorbable suture (laminated group). Esophageal angiography was performed in 1 week, 1 month, and 3 months after the operation. The diameter of anastomatic stoma was measured on the anteroposterior and lateral angiography image respectively. The area of anastomatic stoma was calculated. The degree of stenosis was assessed according to the patients' dysphagia symptom. RESULTS: There was no operative deaths, no serious pulmonary complications and chylothorax, no sever esophageal reflux in all patients. The ratio of cervical esophagogastric anastomotic leakage was 2.1% (2/96) in the varus group. No anastomotic leakage in the laminated group. Compared with the varus group, the area of the anastomatic stoma in the laminated group was significantly increased in all measured time points (P<0.01). The incidence of obstruction in the laminated group was decreased significantly (P<0.01) in 1 month or in 3 months after operation compared with the varus group. CONCLUSION Application of the laminated anastomosis with absorbable suture in cervical esophagogastrostomy can significantly reduce the incidence of anastomotic stenosis.
Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; adverse effects ; methods ; Biocompatible Materials ; Carcinoma, Squamous Cell ; surgery ; Esophageal Neoplasms ; surgery ; Esophageal Stenosis ; etiology ; prevention & control ; Esophagectomy ; methods ; Female ; Gastrostomy ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Suture Techniques

When replacing percutaneous endoscopic gastrostomy (PEG) tubes, an internal bolster may be retrieved either percutaneously or endoscopically. The aim of this study was to compare the complications of percutaneous and endoscopic method during PEG tube replacement. The medical records of 330 patients who received PEG tube replacement were retrospectively analyzed. According to the removal method of internal bolster, we categorized as endoscopic group and percutaneous group. Demographic data, procedure-related complications and risk factors were investigated. There were 176 cases (53.3%) in endoscopic group and 154 cases (46.7%) in percutaneous group. The overall immediate complication rate during PEG tube replacement was 4.8%. Bleeding from the stoma (1.3%) occurred in percutaneous group, whereas esophageal mucosal laceration (7.4%) and microperforation (0.6%) occurred in endoscopic group. The immediate complication rate was significantly lower in the percutaneous method (OR, 6.57; 95% CI, 1.47-29.38, P=0.014). In multivariate analysis, old age was a significant risk factor of esophageal laceration and microperforation during PEG tube replacement (OR, 3.83; 95% CI, 1.04-14.07, P=0.043). The percutaneous method may be more safe and feasible for replacing PEG tubes than the endoscopic method in old patients.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Demography ; Esophageal Perforation/etiology ; Female ; Gastroscopy ; Gastrostomy/adverse effects/*methods ; Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; *Postoperative Complications ; Retrospective Studies ; Risk Factors ; Young Adult