title: Percutaneous endoscopic gastrostomy (PEG): comparison of push and pull methods and evaluation of antibiotic prophylaxis.
abstract: OBJECTIVE
  Infection of the gastrostomy opening after placement of a percutaneous endoscopic gastrostomy (PEG) catheter has been reported to occur quite often, especially when the pull method is used. We therefore compared complications occurring with the pull and push methods, and evaluated the role of antibiotic prophylaxis.
  
  
  METHODS
  In a prospective study, 100 consecutive patients were randomly assigned to group A (pull plus antibiotic prophylaxis: amoxycillin-clavulanic acid 3 x 1.2 g i.v. over 24 hours; 37 patients), group B (pull without antibiotic prophylaxis; 34 patients) and group C (push without antibiotic prophylaxis; 29 patients). The indications for PEG placement were dysphagia due to oropharyngeal tumors (56%), neurological disease (32%), or other (12%). Patients were evaluated twice weekly for one month after the PEG placement.
  
  
  RESULTS
  PEG catheters were successfully placed in 96% of the patients. The total procedure-related complication rate was significantly lower in group A than in groups B and C (28%, 58%, and 70%, respectively; p < 0.01). Major complications occurred in one patient in group A (seeding metastasis of a hypopharyngeal carcinoma in the gastrostomy tract), and in four patients in group B (three cases of peritonitis and one aspiration, resulting in two deaths), but in none of the group C patients. Group A patients experienced fewer peristomal infections than the other two groups (14%, 30%, and 41%, respectively: p = 0.05). The risk of peristomal pain was similar (11%, 15%, and 11%, respectively; p = n.s.). In three patients in group C, the PEG catheter had to be replaced by the pull method, due to repeated dislocation of the balloon catheter.
  
  
  CONCLUSIONS
  The complication rate with PEG placement is high with both the push and pull methods. The complication rate with the pull method is significantly reduced when antibiotic prophylaxis is used.
authors.affiliation: Department of Surgery, Utrecht University Hospital, The Netherlands.
authors.forename: W L
authors.initials: WL
authors.lastname: Akkersdijk
authors.forename: J D
authors.initials: JD
authors.lastname: van Bergeijk
authors.forename: T
authors.initials: T
authors.lastname: van Egmond
authors.forename: C J
authors.initials: CJ
authors.lastname: Mulder
authors.forename: G P
authors.initials: GP
authors.lastname: van Berge Henegouwen
authors.forename: C
authors.initials: C
authors.lastname: van der Werken
authors.forename: K J
authors.initials: KJ
authors.lastname: van Erpecum
mesh_terms: D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002404:Catheterization / Q000009:adverse effects; D019818:Clavulanic Acid; D002969:Clavulanic Acids / Q000627:therapeutic use*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D002969:Clavulanic Acids; D019818:Clavulanic Acid; D000658:Amoxicillin