Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients.
OBJECTIVE
The purpose of this study was to determine whether gastric feeding tubes placed by the percutaneous endoscopic route resulted in fewer and less severe complications than open surgical gastrostomy (SG).


METHODS
Charts for all trauma patients admitted 1/94 to 12/98, which had an electively placed feeding tube, were individually reviewed. All tube-related complications were recorded. Of 8119 patients screened, 158 (1.9%) met inclusion criteria. Percutaneous endoscopic gastrostomies (PEGs) were placed in 95 (60.1%) and surgical gastrostomies in 63 (39.9%). Most patients (79.1%) had AIS 3 or greater head or spinal cord injury as the primary diagnosis leading to tube placement.


RESULTS
Overall, SG patients were 5.4 times more likely than PEG patients to have a complication from their gastrostomy tube (95% CI, 2.1-13.8). They were 2.6 times more likely to have a major complication (internal leakage, dehiscence, peritonitis, and fistula), and 5.5 times more likely to have a minor complication (unplanned removal, dislodgment, external leak, skin infection, and nonfunction). The groups did not differ on ISS, ICU LOS, total LOS, or mortality (p > 0.05). Overall, a total of 39 individual complications related to tube placement were noted in 26 separate patients (PEG, 7; SG, 19). All four of the major complications requiring operative intervention were in the SG group. There were 31 minor complications, 8 in the PEG group and 27 in the SG group. Mean total charges for placement were also significantly lower in the PEG group than the SG group ($1271 vs. $2761, p < 0.001)


CONCLUSIONS
Gastrostomy tubes placed via the percutaneous endoscopic route had a significantly lower complication rate than surgically placed tubes. In addition, the charges incurred for their placement were also significantly less. Based on the findings of this study, PEG should be considered as the method of choice for gastric feeding tube placement for trauma patients who do not have specific contraindications to the procedure.
Dwyer
Kevin M
KM
Department of Trauma Services, Inova Regional Trauma Center, Falls Church, Virginia 22042-3300, USA.
Watts
Dorraine D
DD
Thurber
John S
JS
Benoit
Ronnie S
RS
Fakhry
Samir M
SM
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005747:Gastric Fistula / Q000209:etiology*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology*; D011183:Postoperative Complications; D012044:Regression Analysis; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000628:therapy*