PERCUTANEUS ENDOSCOPIC GASTROSTOMY (PEG). SUCCESSFUL PLACEMENT AND COMPLICATION RATES. A RETROSPECTIVE STUDY CONDUCTED AT A TETRIARY CENTER

Aims Percutaneous Endoscopic Gastrostomy(PEG)is an endoscopic procedure aiming to create a stoma in order to facilitate the delivering of water and nutrients to the small intestine when oral feeding is impossible or contraindicated.The purpose of this study was to assess the effectiveness and safety of PEG formation in our center.

Methods This was a retrospective study on prospectively acquired data regarding the success and safety of PEG procedures in our center between January 2015 and December 2018.The study includes patients hospitalized for various medical conditions or admitted in order to place a PEG to restore intestinal nutrition. Detailed data from PEG placement were retrieved from the hospital´s electronic recording system.The procedure was executed by experienced endoscopic staff(endoscopists and nurses)of our department assisted by specialized medical staff(ICU doctors,nurses,anesthesiologists,and surgeons)on a case to case base.The pull-through technique was used with a PEG diameter of 24Fr.Patients were excluded from this study when the outcome of the PEG endoscopic procedure was unknown after 7 days.

Results In total,203 PEGs were placed.145(71.4%)patients were men with median age 61.7 years and 58 were women(28.6%)with median age 65.3 years.The main reasons for PEG placement were:Νeurological and neurodegenerative diseases(dementia,multiple sclerosis,stroke,motor neuron disease,etc)in 124/203(61.2%)cases;malignant diseases(neck,larynx,tongue,brain, hematological diseases,etc)ιn 34/203(16.7%)cases;head injuries(road accidents,falls)in 24/203(11.8%)cases;prolonged hospitalization in Intensive Care Units for various reasons(sepsis,aspiration,cardiac arrest,central nervous system infections,suicidal attempts,postoperative complications,burns,etc)in 21/203(10.3%)cases.The rate of successful PEG placement was 92.1%(187/203).Placement of PEG failed in 16 cases:Ιnability to locate a suitable insertion spot 12/16(75%)cases,desaturation of the patient during sedation 3/16(18.75%)cases,and due to a tracheo-esophageal fistula one(6.25%)patient.One patient died within 2 days after PEG placement.Serious complications occurred in 4 patients within 7 days after insertion.Aspiration pneumonia 3/203(1.5%)and bleeding 1/203(0.5%)patient.11/203 patients(5.4%)experienced minor complications:trauma infection or leak of the stoma[4(2%)and3/203(1.5%)patients],unintentional PEG removal[3/203(1.5%)]and obstruction[1/203(0.5%)].

Conclusions PEG placement has high success and safety rates when performed with careful patient selection and close collaboration of specialised personnel.