Prospective evaluation of peristomal cutaneous changes among patients with long-term percutaneous endoscopic gastrostomy.
OBJECTIVE
Percutaneous endoscopic gastrostomy (PEG) is the most commonly used procedure in patients requiring long-term tube feeding. Lack of universal terminology and variations in the description of long-term PEG cutaneous lesions make it difficult for clinicians to interpret, communicate, and formulate a plan of treatment. The authors designed a prospective study to assess the long-term PEG cutaneous lesions and the healthcare utilization.


METHODS
After the PEG procedure, patients followed up for more than 12 months were included. Results of physical examination of the PEG cutaneous lesions were recorded. Laboratory tests, including the standard urine strip test, which detected the presence of bilirubin, microbiologic culture, as well as computed tomography, were applied in patients with PEG long-term cutaneous complications. Unscheduled hospital visits also were recorded.


RESULTS
The mean follow-up duration after PEG was 28 ± 15 months. Among patients with long-term PEG, 33.6% of the patients had normal skin, 31.0% had skin erythema, 21.2% had wound discharge, 24.8% had granulation tissue, 15.0% had postinflammatory hyperpigmentation, 15.9% had scarring, 5.3% had side torsion, 29.2% had stoma retraction, and 5.3% had bulging lesions. Urine strip test can differentiate gastric content leakage from purulent exudate/serous fluid. All patients with bulging lesions required hospitalization.


CONCLUSIONS
Long-term PEG cutaneous problems are common. Appropriate physical examinations and laboratory tests can provide evidence to identify the causes, treat the patients with the PEG cutaneous problems, and decrease the risk for potential unscheduled hospital visits.
Wei-Kuo Chang, MD, PhD, is a Gastroenterologist and Chief of Digestive Endoscopy, Division of Gastroenterology, Department of Internal Medicine; Ning-Chi Wang, MD, is an infectious disease specialist, Division of Infection, Department of Internal Medicine; Wei-Ming Wang, MD, PhD, is a Dermatologist and head of Department of Dermatology, Department of Dermatology; and Jeng-Feng Chen, MD, is a Consultant Dermatologist, Department of Dermatology; all at Tri-Service General Hospital, National Defense Medical Center, Taiwan, Republic of China.
Wei-Kuo
WK
Chang
Ning-Chi
NC
Wang
Wei-Ming
WM
Wang
Jeng-Feng
JF
Chen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D017592:Skin Care / Q000379:methods; D012871:Skin Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology