title: Percutaneous Endoscopic Gastrostomy for Decompression of Nonmalignant Gastrointestinal Disease.
abstract: BACKGROUND
  The utility of percutaneous endoscopic gastrostomy (PEG) decompression for inoperable malignant bowel obstruction is well documented. However, there are limited data on decompressive PEG for prolonged ileus, gut dysmotility, and/or complicated nonmalignant bowel obstruction. The aim of this study was to assess the safety and short-term outcomes of decompressive PEG for nonmalignant indications.
  
  
  METHODS
  After Institutional Review Board approval, we retrospectively reviewed and analyzed all PEG insertions completed at our institution between 2009 and 2014 for prolonged ileus, gut dysmotility, or nonmalignant obstruction.
  
  
  RESULTS
  We identified 72 patients (42 females, 30 males; mean age, 58.8 ± 15.2 years) who underwent decompressive PEG for nonmalignant indications. There were no procedural complications or mortalities. The mean pre- and postprocedural length of stays were 14.4 ± 10.7 and 7.6 ± 11.1 days, respectively (P = .0003). The 30-day re-admission rate was 12.5% (9 patients; the majority for unrelated issues). Fifty-two (72%) of the 72 patients were discharged with a PEG for decompression for a median of 69.5 (range, 17-316) days; the remaining 20 (28%) patients were lost to follow-up and were assumed to continue follow-up with their primary referring center. Of the 72 patients, 63 (87.5%) were discharged on total parenteral nutrition (TPN); 36 (50%) of those continued to receive TPN for a median of 51 (range, 4-316) days after discharge, and resolution of their mechanical obstruction was ultimately achieved, so that they subsequently resumed enteral nutrition. Twenty-four (33%) patients were lost to follow-up; because they were referred to our tertiary referral center, we assumed they continued follow-up at their referring institution. Three (4%) patients ultimately went on to use TPN indefinitely and thus were considered to be chronically TPN-dependent.
  
  
  CONCLUSIONS
  Decompressive PEG insertion is safe and effective at alleviating obstructive symptoms in patients with prolonged postoperative ileus, gut dysmotility, and/or complicated nonmalignant obstruction.
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Daigle
authors.affiliation: 2 Digestive Disease Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mena
authors.initials: M
authors.lastname: Boules
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.|3 Foundation Clinic for Biomedical Research, Hospital Clinic of Barcelona, University of Barcelona , Barcelona, Spain .
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles
authors.affiliation: 2 Digestive Disease Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: McMichael
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.|2 Digestive Disease Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.affiliation: 2 Digestive Disease Institute , Cleveland Clinic, Cleveland, Ohio.|4 Digestive Disease Institute , Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates .
authors.forename: Kevin
authors.initials: K
authors.lastname: El-Hayek
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005769:Gastrointestinal Motility; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D045823:Ileus / Q000601:surgery*; D007415:Intestinal Obstruction / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D010359:Patient Readmission; D012189:Retrospective Studies; D013997:Time Factors