title: Percutaneous endoscopic gastrostomy in patients with ventriculoperitoneal shunt.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) placement in patients with ventriculo-peritoneal shunt (VPS) may be associated with complications. This study reports our experience of PEG in patients with VPS.
  
  
  METHODS
  Consecutive patients undergoing PEG insertion in a gastroenterology unit over 18 month's period were retrospectively analyzed. All patients were evaluated by an attending gastroenterologist for fitness for procedure. Instructions were given for routine antibiotic prophylaxes before the procedure and continued for 48 hours. Patients were followed for immediate complications in particular, wound infection, signs of meningitis, deterioration in neurological state and shunt malfunction. Post discharge, patients were given routine follow-up for review.
  
  
  RESULTS
  Of 86 patients who had PEG inserted during the study period, 14 had VPS including 2 of which had VPS after PEG. The main common indications for VPS were intracerebral bleed and head trauma and for PEG were requirement of long term enteral feeding. Twelve patients had PEG at a mean interval of 61 days (range 1-187 days) after VPS. Of these, eight received prophylactic antibiotic or were on antibiotic for other indications before PEG. Two patients developed mild PEG site infections within a week of insertions, including one patient who was not given antibiotic prophylaxis, both treated successfully with antibiotics. The latter patient developed worsening hydrocephalus secondary to VPS blockage. At a mean follow-up period was 140 days (range 20-570 days), there were no death or further complications encountered.
  
  
  CONCLUSIONS
  Although safe in the majority of patients with VPS, PEG infection can lead to intracranial complications. We recommend antibiotic prophylaxis for VPS patients before PEG.
authors.affiliation: Raja Isteri Pengiran Anak Saleha Hospital, Department of Medicine, Jalan Tutong, Bandar Seri Begawan, Brunei Muara BA 1710 Brunei Darussalam. chongvuih@yahoo.co.uk.
authors.forename: H C
authors.initials: HC
authors.lastname: Vui
authors.affiliation: Tan Tock Seng Hospital, Department of Gastroenterology.
authors.forename: W C
authors.initials: WC
authors.lastname: Lim
authors.affiliation: Tan Tock Seng Hospital, Department of Pharmacy.
authors.forename: H L
authors.initials: HL
authors.lastname: Law
authors.affiliation: Tan Tock Seng Hospital, Department of Gastroenterology.
authors.forename: B
authors.initials: B
authors.lastname: Norwani
authors.affiliation: Tan Tock Seng Hospital, Department of Gastroenterology.
authors.forename: V U
authors.initials: VU
authors.lastname: Charles