[Percutaneous endoscopic gastrostomy. Complications with and without anticoagulation].
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) has been classified to date as a high-risk procedure (ASGE guidelines). Coagulopathies, thrombocyte aggregation inhibitors (Aspirin, clopidogrel etc.) and phenprocoumone or warfarin are considered to be contraindications. The study examined for the first time the risk factors in patients with and without concurrent anticoagulation.


METHODS
Between 2001 and 2007 PEGs were placed in 450 patients with neurological diseases at the University Hospital for General and Visceral Surgery in Freiburg and studied prospectively during hospitalization. The patients were divided into 3 groups: group 1 controls (n=50, no anticoagulation), group 2 low-molecular-weight heparin (LMWH) prophylaxis (n=152) and group 3 therapeutic anticoagulation (unfractionated heparin, phenprocoumone, therapeutic LMWH, aspirin, clopidorel and combinations, n=248). Univariate analyses were performed to determine risk factors for the occurrence of infection, bleeding and peritonitis. The p-values (p), odds ratios (OR) and 95% confidence intervals (CI) are given.


RESULTS
The average hospitalization time was 27.4 days (range 1-268 days) and hospital mortality was 6%. There were no cases of death due to the PEG. Complications included peristomal infections (n=30, 6.6%) and peritonitis (n=6, 1.3%). Post-PEG bleeding did not occur either with or without anticoagulation. The investigated risk factors showed no statistically significant values with respect to prognosis for these complications. Multivariate testing could not be carried out due to the low number of complications.


CONCLUSIONS
Complications of PEG placement with the method used here are rare. An increased risk of bleeding during therapeutic anticoagulation was not observed. In our opinion the present data indicate that PEG placement can be carried out in selected patients with increased risk of thromboembolism without discontinuation of anticoagulation.
Ruthmann
O
O
Klinik für Allgemein- und Viszeralchirurgie mit Poliklinik, Albert-Ludwigs-Universität, Freiburg im Breisgau.
Seitz
A
A
Richter
S
S
Marjanovic
G
G
Olschewski
M
M
Hopt
U T
UT
Fischer
A
A
Schrag
H-J
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D000077144:Clopidogrel; D000075202:Contraindications; D004359:Drug Therapy, Combination; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000209:etiology; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013923:Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin