Successful control of peristomal infection by introducer-type percutaneous endoscopic gastrostomy: a retrospective historical control study.
BACKGROUND
The techniques of percutaneous endoscopic gastrostomy are classified as the pull and introducer methods. Peristomal infection is the most common procedure-related complication in the pull method.


OBJECTIVE
The objective of this study was to compare procedure-related complications between the two methods and to assess the outcome of long-term use of the introducer method.


METHODS
Between January 1999 and November 2009, 116 patients received percutaneous endoscopic gastrostomy at Seoul St. Mary's Hospital in Korea. Before June 2006, the pull method was used for all patients; since then, every patient had been treated using the introducer method. We compared outcomes and complications within 180 days of gastrostomy placement for the two methods.


RESULTS
The pull method was performed on 63 patients and the introducer method on 53 patients. The occurrence of peristomal infection within 30 days was significantly lower in the introducer method group than in the pull method group (1.9% vs. 36.5%, P = 0.001). Methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the major organisms isolated from the peristomal infection. The requirement for catheter reinsertion because of displacement, obstruction, or damage to the catheter between 30 and 180 days was significantly higher in the introducer method group than in the pull method group (40.5% vs. 0%, P = 0.001).


CONCLUSIONS
Our results suggest the superiority of the introducer method in terms of infection control. However, the balloon-type catheter is associated with problems such as balloon insufficiency in long-term use.
Department of Internal Medicine, The Catholic University of Korea College of Medicine, 505, Banpo-dong, Seocho-gu, Seoul, 137-070, Korea.
Chul-Hyun
CH
Lim
Jae Myung
JM
Park
Yu Kyung
YK
Cho
In Seok
IS
Lee
Sang Woo
SW
Kim
Myung-Gyu
MG
Choi
In-Sik
IS
Chung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome
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