[Indications and complications of percutaneous endoscopic gastrostomy].
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) plays an important role in maintaining enteral nutrition in patients with swallowing disorders of different etiologies. The aim of our study was to record indications and complications of PEG-placement in a one-year period.


METHODS
All patients were investigated prospectively regarding indications, wound infections, other complications and mortality between 1999-10-01 and 2000-09-30. The exit site was examined daily, after 30 days a follow-up by telephone was carried out.


RESULTS
The PEG-procedure was performed in 93 patients, one patient received a percutaneous endoscopic jejunostomy. The mean age of the patients was 65.4 years (range 7 months--92 years). The most frequent indications were neurological diseases (n = 61, 65%). 21 patients had a PEG-placement because of malignancies (22%), 9 patients following brain injury (10%) and 3 patients (3%) due to other benign swallowing disorders. 63 patients (67%) had no complications, 28 patients (30%) had wound infections, and in two patients hemorrhage was observed (small hematoma requiring no further intervention). One patient had laparotomy because of suspected perforation--however, laparotomy was negative. In 7 patients (7%) wound infections (n = 28) were mild and needed only local or no therapy. In 18 patients (19%) we found a relevant infection that required systemic antibiotic therapy. 2 patients had serious local infections that caused further interventions. One patient died from sepsis caused by wound infection. Patients receiving antibiotic therapy at the time of PEG-placement suffered from wound infections in 25%. Patients with malignant diseases more often had wound infections. 8 patients died after 7 days and 19 patients after 30 days (8% and 19%, respectively) from their underlying disease.


CONCLUSIONS
PEG is regarded as a small intervention with low morbidity and mortality. However, our analysis of daily practice shows a remarkable rate of complications. The high mortality in our study reflects the seriousness of the comorbidities. Antibiotic therapy failed to prevent wound infection in 25% of our patients.
Aschl
Gerhard
G
I. Interne Abteilung/Gastroenterologie, Allgemein öffentliches Krankenhaus der Barmherzigen Schwestern v. Hl. Kreuz, Wels, Osterreich. gerhard.aschl@khwels.at
Kirchgatterer
Andreas
A
Allinger
Stephan
S
Hinterreiter
Max
M
Hubner
Dietmar
D
Kranewitter
Wolfgang
W
Stadler
Bernhard
B
Wimmer
Ludwig
L
Knoflach
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D001930:Brain Injuries / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004724:Endoscopy; D004750:Enteral Nutrition; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009422:Nervous System Diseases / Q000150:complications; D011446:Prospective Studies; D013997:Time Factors; D014946:Wound Infection / Q000209:etiology / Q000517:prevention & control / Q000628:therapy