Komplikationen nach Anlage einer perkutanen endoskopischen Gastrostomie – eine retrospektive Analyse

Zusammenfassung

Bei Patienten mit maligner Grunderkrankung oder benignen Schluck- und Passagestörungen ist eine physiologische, enterale Ernährung die Basis zur Vermeidung kataboler Stoffwechselvorgänge. Hier hat sich die Anlage einer perkutanen endoskopischen Gastrostomie (PEG) bewährt. Deren Überlegenheit gegenüber anderen Verfahren konnte in klinischen Studien wiederholt nachgewiesen werden. Trotz geringer Invasivität weist die Anlage einer PEG jedoch eine nicht unerhebliche Komplikationsrate auf. Patienten und Methoden: Es wurde eine retrospektive Analyse der PEG-Anlagen zwischen Januar 2005 und Dezember 2012 im Universitätsklinikum Bonn durchgeführt. Ergebnisse: Bei insgesamt 641 PEG-Anlagen lag die Gesamtkomplikationsrate bei 9,4 %. Davon waren 5,5 % Minorkomplikationen (MiK) und 3,9 % Majorkomplikationen (MaK). Zwei Patienten sind verstorben. Endoskopisch lag die Komplikationsrate bei 8,5 % (4,8 % MiK, 3,8 % MaK). Die MaK waren zu 63,2 % Perforationen, zu 15,8 % intraabdominelle Abszesse und zu 15,8 % ein Buried-Bumper-Syndrom. Die CT-gesteuerte PEG-Anlage ergab eine Komplikationsrate von 38,9 % (27,8 % MiK und 11,1 % MaK). Die MaK waren allesamt Hohlorganperforationen. Bei der offen-chirurgischen Methode konnte eine MiK von 7,7 % nachgewiesen werden. Hier gab es keine MaK. Schlussfolgerung: Auch in unserem Patientenkollektiv zeigte sich eine beachtliche Komplikationsrate. Daher sollte die Indikation kritisch hinterfragt und die Implantationstechnik im Konsens festgelegt werden. Unabdingbar für eine geringe MiK sind eine ausgezeichnete Nachbetreuung sowie die Schulung des Ärzte- und Pflegepersonals und genaueste Pflegeanweisungen für die Angehörigen und den ambulanten Pflegedienst.

Abstract

Background: Enteral nutrition is vital for patients with inadequate or absent oral food intake, as it can help to avoid catabolic metabolism. Enteral feeding can be secured by placing a percutaneous endoscopic gastrostomy tube (PEG-tube) which is an approved method. Several clinical studies could verify the superiority of this procedure compared to other options. Even though PEG-tube placement is regarded as less invasive surgery, a considerable rate of complications is reported in literature. Material/Methods: Here, we report a retrospective analysis of PEG-tube placements in the Bonn University Hospital from January 2005 to December 2012. Results: Overall, 641 PEG-tubes were placed with a complication rate of 9.4 %, which can be further divided in 5.5 % minor complications (mic) and 3.9 % major complications (mac). Two cases of death occurred in the context of PEG-tube placement. Endoscopically inserted PEG-tubes showed a complication rate of 8.6 % (4.8 % mic, 3.8 % mac). 63.2 % of mac consisted of perforations, 15.8 % of intra-abdominal abscesses and 15.8 % of buried bumper syndromes. The complication rate of CT-guided placement of PEG-tubes was 38.9 % (27.8 % mic, 11.1 % mac). In this group, all mac were perforations. Surgical PEG-tube placement was accompanied by no mac and 7.7 % mic. Conclusion: The amount of complications during PEG-tube placement is remarkable, therefore the indication of this procedure must be contemplated critically and careful follow-up is crucial.

Schlüsselwörter

perkutane endoskopische Gastrostomie - Komplikationsrate - enterale Ernährung

Key words

percutaneous endoscopic gastrostomy tube - complication rate - enteral nutrition

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