title: Efficacy of an overtube for reducing the risk of peristomal infection after PEG placement: a prospective, randomized comparison study.
abstract: BACKGROUND
  With the conventional pull method of PEG placement, there is a significant risk of wound infection from contamination of the gastrostomy catheter as it passes through the oral cavity. This study compared the occurrence of peristomal wound infection associated with PEG placement with and without use of an overtube.
  
  
  METHODS
  Consecutive patients with dysphagia were randomized to undergo PEG placement with (Group I) or without (Group II) an overtube. For each patient, the peristomal area was evaluated daily for 1 week after PEG placement. The presence of erythema and of exudate were scored on a scale of 0 to 4; induration was scored on a scale of 0 to 3. Criteria for infection were a maximum combined score of 8 or higher, or the presence of microscopic and microbiologic evidence of suppurating exudate. In each group, cefazolin was administered prophylactically (2 g/d intravenously) for 3 days. For patients who had received an antibiotic(s) before PEG placement, the same antibiotic(s) was used. All procedures in both groups were performed by one of two investigators who used the pull method.
  
  
  RESULTS
  A total of 76 patients were randomized; 3 were excluded from analysis, because death occurred within 1 week after the procedure. Two of 3 deaths were procedure-related (aspiration pneumonia in Group I, peritonitis in Group II). Data for 37 patients in Group I and 36 in Group II were analyzed. There was no significant difference between the groups with respect to baseline characteristics. The occurrence of peristomal infection within 1 week of PEG was significantly lower in Group I compared with Group II (2 vs. 12; p = 0.0029). The mean daily combined scores in Group I also were significantly lower than those in Group II ( p < 0.0001), and the median maximum parameter scores in Group I were significantly lower than those in Group II (erythema, p = 0.0062; induration, p = 0.0390; exudate, p < 0.0001), although the nominal significance for induration was removed by correction for the multiple testing of data. One patient excluded from Group II died from sepsis because of procedure-induced peritonitis. Among the 73 enrolled patients, there was no procedure-related mortality or clinically important wound infections that required surgical intervention in either group.
  
  
  CONCLUSIONS
  Use of an overtube during PEG placement reduces the risk of peristomal wound infection.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan.
authors.forename: Iruru
authors.initials: I
authors.lastname: Maetani
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Yasuda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Seike
authors.forename: Masaki
authors.initials: M
authors.lastname: Ikeda
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tada
authors.forename: Takeo
authors.initials: T
authors.lastname: Ukita
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome