Evaluation of percutaneous endoscopic feeding tube placement in obese patients.
BACKGROUND
Percutaneous endoscopic feeding tube placement is generally safe and effective for establishing enteral access. In certain subpopulations, such as obese patients, substantial data are limited. This study evaluates the success rate and potential for late complications with placement of feeding tubes in obese patients.


METHODS
The Medical University of South Carolina endoscopy database was queried for adult patients with a body mass index >or=30 kg/m(2) who had undergone percutaneous endoscopic gastrostomy, percutaneous endoscopic gastrojejunostomy, and direct percutaneous jejunostomy placement procedures between the years 2000 and 2006.


RESULTS
Sixty-seven subjects met the inclusion criteria. Percutaneous endoscopic feeding tube placement was successful in 60 of 67 individuals (89.6%) with an average procedure time of 15.5 minutes (range, 5-70 minutes). Postplacement complications occurred in 26 of 59 subjects (44.1%) and included peristomal pain (8.5%), cellulitis (8.5%), inadvertent removal (6.8%), peritubular leak (6.8%), nausea (3.4%), and hemoperitoneum (3.4%). In multivariable logistic regression analysis, weight >250 pounds (>113 kg) predicted a significantly increased likelihood of complications (adjusted odds ratio = 3.86; 95% confidence interval, 1.02-14.57). Other covariates did not significantly affect the complication rate.


CONCLUSIONS
Percutaneous enteral access device placement in obese patients is generally safe, and a body mass index >or=30 kg/m(2) alone should not be a procedural contraindication. Adherence to safe enteral access placement techniques and close periprocedure follow-up should occur in obese patients, especially those weighing >250 pounds (>113 kg). More research is needed to fully evaluate the efficacy of enteral access in this population.
Wiggins
Travis F
TF
Ochsner Clinic Foundation, Department of Gastroenterology and Hepatology, New Orleans, LA 70121, USA. twiggins@ochsner.org
Garrow
Donald A
DA
DeLegge
Mark H
MH
D015992:Body Mass Index; D001835:Body Weight; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D007582:Jejunostomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D016017:Odds Ratio; D016896:Treatment Outcome