title: Safety and feasibility of interventional pulmonologists performing bedside percutaneous endoscopic gastrostomy tube placement.
abstract: BACKGROUND
  Prior to the 1980s, permanent feeding tube placement was limited to an open surgical procedure until Gauderer and colleagues described the safe placement of percutaneous endoscopic gastrostomy (PEG) tubes. This procedure has since expanded beyond the realm of surgeons to include gastroenterologists, thoracic surgeons, and interventional radiologists. In some academic centers, interventional pulmonologists (IPs) also perform this procedure. We describe the safety and feasibility of PEG tube placement by IPs in a critically ill population.
  
  
  METHODS
  Prospectively collected data of patients in a medical ICU undergoing PEG tube placement from 2003 to 2007 at a tertiary-care center were reviewed. Inclusion criteria included all PEG tube insertions performed or attempted by the IP team. Data were collected on mortality, PEG tube removal rate, total number of days with PEG tube, and complication rates. Follow-up included hospital length of stay and phone contact after discharge. Procedural and long-term PEG-related complications were recorded.
  
  
  RESULTS
  Seventy-two patients were studied. PEG tube insertion was completed successfully in 70 (97.2%), with follow-up data in 69 of these 70. Thirty-day mortality was 11.7%. No deaths or immediate complications were attributed to PEG tube placement. PEG tube removal occurred in 27 patients, with a median time to removal of 76 days.
  
  
  CONCLUSIONS
  Bedside PEG tube placement can be performed safely and effectively by trained IPs. Because percutaneous tracheostomy is currently performed by IPs, the ability to place both PEG and tracheostomy tubes at the same time has the potential for decreased costs, anesthesia exposure, procedural times, ventilator times, and ICU days.
authors: Department of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD. Electronic address: lyarmus@jhmi.edu.
authors: Lonny
authors: L
authors: Yarmus
authors: Department of Pulmonary, Allergy, and Critical Care Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
authors: Christopher
authors: C
authors: Gilbert
authors: Department of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD.
authors: Noah
authors: N
authors: Lechtzin
authors: Pulmonary Medicine of Virginia Beach, Virginia Beach, VA.
authors: Melhem
authors: M
authors: Imad
authors: Pulmonary, Critical Care and Sleep Medicine, St. Elizabeth's Medical Center, Boston, MA.
authors: Armin
authors: A
authors: Ernst
authors: Department of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD.
authors: David
authors: D
authors: Feller-Kopman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D020878:Device Removal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies; D015272:Pulmonary Medicine; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome