A PROSPECTIVE STUDY OF COMPLICATIONS RELATED TO PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN ICU PATIENTS

BACKGROUND The first percutaneous endoscopic gastrostomy performed on a child was on June 12, 1979, at the Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, Dr. Michael W.L. Gauderer, paediatric surgeon; Dr. Jeffrey Ponsky, endoscopist; and Dr. James Bekeny, surgical resident, performed the procedure on a 4 1 ⁄2-month-old child with inadequate oral intake. The authors of the technique, Dr. Michael W.L. Gauderer and Dr. Jeffrey Ponsky, first published the technique in 1980. In 2001, the details of the development of the procedure were published. Gastrostomy maybe indicated in numerous situations usually those in which normal or nutrition (or nasogastric) feeding is impossible. The causes for these situations maybe neurological (e.g. stroke), anatomical (e.g. cleft lip and palate during the process of correction) or other (e.g. radiation therapy for tumours in head and neck region). In certain situations where normal or nasogastric feeding is not possible, percutaneous endoscopic gastrostomy maybe of clinical benefit. This provides enteral nutrition (making use of the natural digestion process of the gastrointestinal tract) despite bypassing the mouth; enteral nutrition is generally preferable to parenteral nutrition (which is only used when the GI tract must be avoided). The PEG procedure is an alternative to open surgical gastrostomy insertion and does not require a general anaesthetic; mild sedation is typically used. PEG tubes may also be extended into the small intestine by passing a jejunal extension tube (PEG-J tube) through the PEG tube and into the jejunum via the pylorus. MATERIALS AND METHODS The present study was carried out in the Department of General Medicine on 32 patients who underwent PEG placement by gastroenterologist at Gayatri Vidya Parishad Hospital, Visakhapatnam, from January 2016 to December 2016. Patients were aged 18 years and above. All patients had placement of Ponsky pull PEs either in the endoscopy room or intensive care unit. RESULTS A total 330 cases of PEG tube were replaced. The mean age was 56.4 ± 18.4 yrs. (range, 18 to 84) and 224 (67.9%) patients were male. Most common comorbid diseases were cerebral infarction (217 cases, 65.8%), followed by hypoxic brain damage (36 cases, 10.9%). When associated with bleeding, aspirin (43 cases, 13.0%) was the most frequently taken drug in both groups. The mean interval of PEG tube placement was 6.3 ± 2.5 months (range, 0.8 to 18.3 months) and mean procedure time was 11.2 ± 3.8 mins. (range, 4.4 to 18.2 mins.). CONCLUSION PEG was a safe and effective way of providing access for both short-term and long-term enteral nutrition. PEG tube placement for patients who cannot be fed orally is a minimally-invasive procedure with low morbidity and mortality