GP.03 Outcomes after gastrostomy tube placement in patients with acute stroke: A 10-year population-based study using the Ontario Stroke Registry

Background: Dysphagia is a common and devastating complication after acute stroke. Percutaneous endoscopic gastrostomy (PEG) tubes are often placed for persistent dysphagia. However, little is known regarding outcomes after PEG tube placement. Methods: We used a 10-year Ontario Stroke Registry to shed light on the clinical outcomes of patients with PEG tube insertion after ischemic stroke or intracranial hemorrhage compared to patients with only NG tubes, including rate of pneumonia, disability, and mortality. Results: Using propensity score matching, 1,793 patients were successfully matched and had similar baseline characteristics. Compared with NG, patients with PEG had a higher rate of pneumonia (32.6% vs. 20.6%; RR 1.59), higher disability at discharge (modified Rankin Scale Score 3-5; 74.0% vs. 65.4%; RR 1.13), and higher rate of long-term care placement (27.1% vs. 9.3%; RR 2.9). >From stroke onset, there was a lower rate of death in patients with PEG compared to NG at 30 days (15.3% vs. 34.3%; RR 0.45) but no difference at 2 years (52.8% vs. 53.5%; RR 0.99, p=0.71). *All significant p <0.0001. Conclusions: In conclusion, PEG tube placement after stroke may prolong survival in patients with poor outcomes. Our study provides a framework for discussions between physicians, patients, and families with regards to expected prognosis after PEG tube placement.

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Percutaneous Endoscopic Gastrostomy Tube Placement in Elderly Patients from a South Carolina Long Term Care Facility

Journal of Nutrition for the Elderly ◽

10.1300/j052v14n02_08 ◽

1995 ◽

Vol 14 (2-3) ◽

pp. 89-96

Author(s):

Cass Ryan ◽

Jeanne Byrd ◽

Paul Eleazer

Keyword(s):

South Carolina ◽

Long Term Care ◽

Care Facility ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Term Care ◽

Long Term Care Facility ◽

Endoscopic Gastrostomy ◽

Gastrostomy Tube Placement

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Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients

Endoscopy International Open ◽

10.1055/s-0043-106582 ◽

2017 ◽

Vol 05 (07) ◽

pp. E603-E607 ◽

Cited By ~ 8

Author(s):

Daniela Mueller-Gerbes ◽

Bettina Hartmann ◽

Julio Lima ◽

Michele de Lemos Bonotto ◽

Christoph Merbach ◽

...

Keyword(s):

Retrospective Cohort ◽

Treatment Success ◽

Tube Placement ◽

Endoscopic Gastrostomy ◽

Tube Removal ◽

Tube Dysfunction ◽

Gastrostomy Tube Placement ◽

Buried Bumper Syndrome ◽

Needle Knife ◽

Peg Tube

Abstract Background and study aims Buried bumper syndrome is an infrequent complication of percutaneous endoscopic gastrostomy (PEG) that can result in tube dysfunction, gastric perforation, bleeding, peritonitis or death. The aim of this study was to compare the efficacy of different PEG tube removal methods in the management of buried bumper syndrome in a large retrospective cohort. Patients and methods From 2002 to 2013, 82 cases of buried bumper syndrome were identified from the databases of two endoscopy referral centers. We evaluated the interval between gastrostomy tube placement and diagnosis of buried bumper syndrome, type of treatment, success rate and complications. Four methods were analyzed: bougie, grasp, needle-knife and minimally invasive push method using a papillotome, which were selected based on the depth of the buried bumper. Results The buried bumper was cut free with a wire-guided papillotome in 35 patients (42.7 %) and with a needle-knife in 22 patients (26.8 %). It could be pushed into the stomach with a dilator without cutting in 10 patients (12.2 %), and was pulled into the stomach with a grasper in 12 patients (14.6 %). No adverse events (AEs) were registered in 70 cases (85.4 %). Bleeding occurred in 7 patients (31.8 %) after cutting with a needle-knife papillotome and in 1 patient (8.3 %) after grasping. No bleeding was recorded after using a standard papillotome or a bougie (P < 0.05). Ten of 22 patients (45.5 %) treated with the needle-knife had a serious AE and 1 patient died (4.5 %). Conclusions We recommend that incomplete buried bumpers be removed with a bougie. In cases of complete buried bumper syndrome, the bumper should be cut with a wire-guided papillotome and pushed into the stomach.

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Buried Bumper Syndrome Revisited: A Rare but Potentially Fatal Complication of PEG Tube Placement

Case Reports in Critical Care ◽

10.1155/2014/634953 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Saptarshi Biswas ◽

Sujana Dontukurthy ◽

Mathew G. Rosenzweig ◽

Ravi Kothuru ◽

Sunil Abrol

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Gastric Wall ◽

Late Complications ◽

Tube Placement ◽

Endoscopic Gastrostomy ◽

Enteral Access ◽

Delayed Complications ◽

Buried Bumper Syndrome ◽

Peg Tube

Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.

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Meningitis Due to Enterobacter aerogenes Subsequent to Resection of Acoustic Neuroma and Percutaneous Endoscopic Gastrostomy Tube Placement: A Rare Nosocomial Event

Infection Control and Hospital Epidemiology ◽

10.1086/502135 ◽

2003 ◽

Vol 24 (10) ◽

pp. 780-782 ◽

Cited By ~ 2

Author(s):

David M. Poetker ◽

Charles E. Edmiston ◽

Michelle M. Smith ◽

Glenn A. Meyer ◽

Phillip A. Wackym

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Acoustic Neuroma ◽

Enterobacter Aerogenes ◽

Intervention Strategies ◽

Gastrostomy Tube ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Endoscopic Gastrostomy ◽

Gastrostomy Tube Placement ◽

Peg Tube

AbstractWe present a case of meningitis after percutaneous endoscopic gastrostomy (PEG) tube placement subsequent to acoustic neuroma resection and cranioplasty. Four days following PEG tube placement the patient developed Enterobacter aerogenes meningitis, requiring explantation of infected cranioplasty material. His condition subsequently improved. Etiology and future intervention strategies are discussed (Infect Control Hosp Epidemiol 2003;24:780-782).

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Multi Drug Resistant Bacteria and Its Antibiotic Susceptibility at Percutanous Endoscopic Gastrostomy (PEG) Tube Site of Long Term Care Facility Elderly Residents

The Egyptian Journal of Hospital Medicine ◽

10.12816/0039035 ◽

2017 ◽

Vol 68 (2) ◽

pp. 1094-1100

Author(s):

Reem Mohamed Sabry El Bedewy

Keyword(s):

Long Term Care ◽

Care Facility ◽

Resistant Bacteria ◽

Drug Resistant ◽

Term Care ◽

Long Term Care Facility ◽

Endoscopic Gastrostomy ◽

Drug Resistant Bacteria ◽

Peg Tube

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S598 Effect of Hospital Teaching Status on Percutaneous Endoscopic Gastrostomy Tube Placement in Ascites Patients: A Population-Based Study

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000774868.92538.0c ◽

2021 ◽

Vol 116 (1) ◽

pp. S271-S272

Author(s):

Amrita Chawla ◽

Faiz Afridi ◽

Reza Hashemipour ◽

Sushil Ahlawat

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Population Based ◽

Gastrostomy Tube ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Population Based Study ◽

Endoscopic Gastrostomy ◽

Teaching Status ◽

Gastrostomy Tube Placement

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Metastatic Implantation of Head and Neck Squamous Cell Cancer at PEG Tube Site Exit— An Unusual Relapse Site: A Case Report and Review of Literature

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1048 ◽

2011 ◽

Vol 2 (1) ◽

pp. 53-56 ◽

Cited By ~ 2

Author(s):

Vijay Palwe ◽

Kaustav Talpatra ◽

Umesh Mahantshetty ◽

Seethalaxmi Viswanathan

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Percutaneous Endoscopic Gastrostomy ◽

Neck Cancer ◽

Squamous Cell ◽

Gastrostomy Tube ◽

Tube Placement ◽

Endoscopic Gastrostomy ◽

Gastrostomy Tube Placement ◽

Peg Tube

ABSTRACT Background The placement of percutaneous endoscopic gastrostomy (PEG) tubes is a common procedure in patients with head and neck cancer who require adequate nutrition because of the inability to swallow before or after surgery and adjuvant therapies. A potential complication of percutaneous endoscopic gastrostomy tubes is the metastatic spread from the original head and neck tumor to the gastrostomy site. Methods This is a case of a 55-year-old male with a (cT4N3M0) stage IV squamous cell carcinoma of the oropharynx who underwent percutaneous endoscopic gastrostomy tube placement prior to commencement of definitive chemoradiation therapy and 7 months thereafter developed metastatic spread to the gastrostomy site. Tumor was treated with radiation therapy. A review of the published literature regarding the subject is done. The pull-through method of gastrostomy tube placement had been used in our patient as well as in the majority of the other cases reviewed in the literature. Conclusions There is a small but definite risk for tumor implantation in the gastrostomy site when using the pull technique in patients with active head and neck cancer. The direct implantation of tumor through instrumentation is the most likely explanation for metastasis; however, hematogenous seeding is also a possibility. Careful assessment of the oropharynx and hypopharynx before PEG tube placement and the use of alternative techniques for enteral access in patients with untreated or residual malignancy are recommended to minimize this risk.

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Outcomes among patients with direct enteral vs nasogastric tube placement after acute stroke

Neurology ◽

10.1212/wnl.0000000000004962 ◽

2018 ◽

Vol 90 (7) ◽

pp. e544-e552 ◽

Cited By ~ 8

Author(s):

Raed A. Joundi ◽

Gustavo Saposnik ◽

Rosemary Martino ◽

Jiming Fang ◽

Joan Porter ◽

...

Keyword(s):

Acute Stroke ◽

Nasogastric Tube ◽

Tube Feeding ◽

Severe Disability ◽

Tube Placement ◽

Term Care ◽

Risk Of Death ◽

Complications And Mortality ◽

Long Term Mortality

ObjectiveTo compare complications, disability, and long-term mortality of patients who received direct enteral tube vs nasogastric tube feeding alone after acute stroke.MethodsWe used the Ontario Stroke Registry to identify patients who received direct enteral tubes (DET; gastrostomy or jejunostomy) or temporary nasogastric tubes (NGT) alone during hospital stay after acute ischemic stroke or intracerebral hemorrhage from July 1, 2003, to March 31, 2013. We used propensity matching to compare groups from discharge and evaluated discharge disability, institutionalization, complications, and mortality, with follow-up over 2 years, and with cumulative incidence functions used to account for competing risks.ResultsAmong 1,448 patients with DET placement who survived until discharge, 1,421 were successfully matched to patients with NGT alone. Patients with DET had reduced risk of death within 30 days after discharge (9.7% vs 15.3%; hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.49–0.75), but this difference was eliminated after matching on length of stay and discharge disability (HR 0.90, 95% CI 0.70–1.17). Patients with DET had higher rates of severe disability at discharge (modified Rankin Scale score 4–5; 89.6% vs 78.4%), discharge to long-term care (38.0% vs 16.1%), aspiration pneumonia (14.4% vs 5.1%) and other complications, and mortality at 2 years (41.1% vs 35.9%).ConclusionsPatients with DET placement after acute stroke have more severe disability at discharge compared to those with NGT placement alone, and associated higher rates of institutionalization, medical complications, and long-term mortality. These findings may inform goals of care discussions and decisions regarding long-term tube feeding after acute stroke.

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