Percutaneous endoscopic gastrostomy for refractory epilepsy and medication refusal

2019 ◽  
Vol 104 (7) ◽  
pp. 690-692 ◽  
Author(s):  
Caoimhe Howard ◽  
William L Macken ◽  
Ann Connolly ◽  
Maria Keegan ◽  
David Coghlan ◽  
...  
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Seizure Control ◽  
Refractory Epilepsy ◽  
Case Series ◽  
Oral Feeding ◽  
Tube Placement ◽  
Endoscopic Gastrostomy ◽  
Potential Benefits ◽  
Peg Tube ◽  
Hiv Renal Disease

ObjectiveCurrent guidelines for percutaneous endoscopic gastrostomy (PEG) placement focus largely on maintaining enteral feeding when oral feeding is no longer possible or adequate with an emphasis on nutrition and quality of life (QOL). Previous publications have also alluded to potential benefits in medication adherence, for example, in children with HIV, renal disease and neurodisability. We describe a cohort of children with refractory epilepsy who refused oral medication and in whom PEG tube placement was initiated for the purpose of drug administration.DesignWe identified children from the medical records of two tertiary paediatric units over a 9-year period who had PEG tube placement for administration of antiepileptic drug (AED) therapy and collected demographic and clinical details from chart reviews. We assessed parent-reported changes in seizure control and QOL using a structured questionnaire.ResultsTen patients met the inclusion criteria. All families reported an improvement in ease of administering medications and eight reported a significant improvement in QOL. Nine children had a decrease in seizure frequency (lasting more than 12 months) following PEG tube placement, including two who underwent surgical intervention for their epilepsy during that period. Four had either a decrease in the number of drugs administered or their doses and four went on to receive fluids and nutrition through their tube on a regular basis. Seven reported PEG complications, which did not require removal of the PEG.ConclusionsThis case series of children with resistant epilepsy demonstrates improvement in seizure control and QOL following PEG tube placement for AED administration.

Early report on percutaneous endoscopic gastrostomy at Owerri, Nigeria

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Christopher Nonso Ekwunife ◽  
Kelechi E. Okonta ◽  
Stephen E. Enendu
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Early Report ◽  
Cross Sectional Study ◽  
Tube Placement ◽  
Safe Procedure ◽  
Cross Sectional ◽  
Endoscopic Gastrostomy ◽  
Neurologic Disorders ◽  
Superficial Skin ◽  
Peg Tube

Objectives: Percutaneous endoscopic gastrostomy (PEG) is a well-established endoscopic procedure that is used predominantly to create enteral access for feeding. Its use has not been widespread in Nigeria despite its efficacy. This study is done to review the early experiences in the use of PEG in Federal Medical Centre, Owerri and Carez Clinic, Owerri. Material and Methods: This is a 4-year retrospective cross-sectional study of patients who had PEG from January 2015 to December 2018. The indications, complications, and outcomes of the procedure were analyzed. Results: A total of 13 patients had pull-type gastrostomy during this period. Six (46.1%) patients had the procedure on account of neurologic disorders, 4 (30.8%) patients had esophageal tumors, while 3 (23.1%) patients had esophageal motility disorders. The overall success rate for PEG tube placement was 100%. The most common complication was superficial skin infection 30.8% (4/13). No mortality was attributable to the procedure. Conclusion: PEG is still not commonly done in our setting, but it is a relatively safe procedure. Physicians should be encouraged to offer it to our teeming patients with neurologic disorders who may benefit from it.

Safety and efficacy of percutaneous endoscopic gastrostomy tube placement in patients with malignant peritoneal carcinomatosis induced bowel obstruction.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14012-e14012
Author(s):  
Pankaj G Vashi ◽  
Donald Peter Braun ◽  
Brenten Popiel ◽  
Digant Gupta
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Bowel Obstruction ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Insertion Site ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Safety And Efficacy ◽  
Symptom Resolution ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

e14012 Background: Percutaneous Endoscopic Gastrostomy (PEG) tube placement in advanced peritoneal carcinomatosis with bowel obstruction is a feasible palliative procedure to help patients with obstructive symptoms. We describe the safety and efficacy of using PEG tube for decompression in patients with large peritoneal masses. Methods: A consecutive case series of 62 patients (Apr-08 to Jun-11) with advanced abdominal carcinomatosis induced bowel obstruction. All patients were extensively treated for their cancer. None of them were surgical candidates due to extensive peritoneal involvement. All patients had symptoms of nausea, vomiting and pain at the time of PEG tube placement. All patients had a 28F (Bard) PEG tube placed for drainage. The primary outcomes of interest were complications and symptom resolution due to PEG tube placement. Frequency of nausea, vomiting and severity of pain was recorded daily in patient charts. Results: 16 were males and 46 females. The mean age was 50.5 years. Most common cancers were ovary, pancreas, colon and stomach. Of 62 patients, 57 patients had expired at the time of this analysis. Of those 57 expired, 49 had PEG tube at the time of death, while 8 had complete resolution of symptoms with PEG tube removed before death. The 5 out of 62 patients who are alive still have the PEG tube for drainage (average 70.4 days). The average duration of PEG tube placement for all patients combined was 70.9 days (range 6-312 days). Relief of nausea, vomiting and pain was observed in 53 (85.5%), 55 (88.7%) and 35 (56.5%) patients respectively. Of a total of 43 patients who had PEG tube placed for >= 30 days, 24 (56%) could continue with their chemotherapy cycles because of symptom resolution. Non life threatening complications of PEG tube placement were observed in 9 (14.5%) patients. 3 had infection at the insertion site, 2 had bleeding and 3 had leaking at the PEG tube site while 1 had aspiration. 6 (9.7%) patients required replacement of the PEG tube due to occlusion. Conclusions: Placement of PEG tube in presence of advanced peritoneal carcinomatosis is safe and effective in relieving obstructive symptoms as well as extending the period of active cancer therapy.

scholarly journals Inadvertent Percutaneous Endoscopic Gastrostomy Tube Placement through the Transverse Colon to the Stomach Causing Intractable Diarrhea: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
David T. Burke ◽  
Andrew I. Geller ◽  
Alexios G. Carayannopoulos ◽  
Richard Goldstein
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Transverse Colon ◽  
Delayed Diagnosis ◽  
Tube Placement ◽  
Common Mechanism ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Tube Removal ◽  
Peg Tube

Background. Among patients with chronic disease, percutaneous endoscopic gastrostomy (PEG) tubes are a common mechanism to deliver enteral feedings to patients unable to feed by mouth. While several cases in the literature describe difficulties with and complications of the initial placement of the PEG, few studies have documented the effects of a delayed diagnosis of a misplaced tube. Methods. This case study reviews the hospitalization of an 82 year old male with an inadvertent placement of a PEG tube through the transverse colon. Photos of the placement in the stomach as well as those of the follow up colonoscopy, and a recording of the episodes of diarrhea during the hospitalization were made. Results. The records of this patient reveal complaints of gastrointestinal distress and diarrhea immediately after placement of the tube. Placement in the stomach was verified by endoscopy, with discovery of the tube only after a follow up colonoscopy. The tube remained in place after this discovery, and was removed weeks after the diarrhea was unsuccessfully treated with antibiotics. After tube removal, the patient recovered well and was sent home.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
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.

scholarly journals Racial and Socioeconomic Disparities in Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement among elderly patients with dementia in the United States from the National inpatient sample

2020 ◽  
Author(s):  
Tanureet Kochar ◽  
Ashraf Abugroun ◽  
Asma Nayyar ◽  
Manar Abdel- Rahman ◽  
Pragnesh J Patel
Keyword(s):  
Elderly Patients ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Low Income ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Advanced Dementia ◽  
National Inpatient Sample ◽  
Endoscopic Gastrostomy ◽  
Icd 10 ◽  
Peg Tube

Abstract Background Placement of percutaneous endoscopic gastrostomy (PEG) tube in patients of advanced dementia has not been shown to improve nutritional status or mortality. The objective is to assess racial and socioeconomic disparities for PEG tube placement from National Inpatient Sample. Methods In a cross-sectional study, the National inpatient sample (NIS) registry was queried for all patients aged ≥ 70 who were diagnosed with dementia during the year 2016. Patients with dementia were identified using the Tenth revision (ICD-10) codes (F0150, F0151, F0280, F0281, F0390, F0391, G300, G301, G308, G309, G3109, G3183). Patients who received PEG tube were identified using ICD-10 diagnosis codes (Z431). Multivariable logistic regression models were utilized to determine the likelihood of PEG tube placement with adjustment for Patients demographics, socioeconomic factors, degree of frailty and comorbidities. Results Out of 1,745,028 patients with dementia, 35,075 patients had PEG tube placed. Majority of patients who received PEG tube were females (54.8%), of white race (45.5%) with a mean age of 82.3 years (SEM 0.02). Compared to controls, those who had PEG tube placement were more frail, had higher prevalence of chronic lung disease, diabetes, stroke, psychosis and nutritional deficiency anemias. On multivariable analysis, higher risk for PEG tube placement was seen in African Americans and Hispanics compared to Caucasians with a-OR 3.76 [95%CI: 3.47–4.07], p < 0.001 and 2.59 [95%CI:2.33–2.88], p < 0.001 respectively. A higher risk was also seen in patients with low income with a-OR 1.1(95%CI: 1.04–1.19), p = 0.002 and among those having Medicaid compared to Medicare insurance with a-OR 1.53 [95%CI: 1.30–1.80], p < 0.001. Compared to males, females were found to have low chances for PEG tube placement with a-OR: 0.78 [95%CO:0.74–0.82], p < 0.001. Hospital ownership, bed size and teaching status were found to have no impact on PEG tube utilization. Conclusion Despite the evidence against placement of PEG tubes in dementia patients, our findings confirm that PEG tubes are still being placed in frail and demented elderly. Apart from these, elderly patients with low income, African American origin and Medicaid enrollees have higher incidence of PEG tube placements. Efforts are needed to educate clinicians and community about worse outcomes of PEG tube placement in advanced dementia.

scholarly journals Persistent Peristomal Leakage from Percutaneous Endoscopic Gastrostomy Successfully Treated with Argon Plasma Coagulation

2020 ◽  
pp. 1-5
Author(s):  
Cláudia Macedo ◽  
Nuno Almeida ◽  
Ana Rita Alves ◽  
Ana Margarida Ferreira ◽  
Pedro Figueiredo
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Low Cost ◽  
Argon Plasma Coagulation ◽  
Case Series ◽  
Argon Plasma ◽  
Tube Placement ◽  
Plasma Coagulation ◽  
Endoscopic Gastrostomy ◽  
Gastrostomy Tube Placement

<b><i>Introduction:</i></b> Percutaneous endoscopic gastrostomy is a safe and effective technique and its use is widely spread. Peristomal leakage may occur within the first few days after gastrostomy tube placement and also in the mature gastrostomy tract. The initial treatment involves conservative measures. If the leakage does not resolve, different endoscopic interventions could be necessary with consequent impairing of enteral nutrition and, in some cases, the need of creating a new gastro-cutaneous fistula. <b><i>Case Report:</i></b> We present 4 consecutive cases complicated with late peristomal leakage and medical treatment failure. These patients underwent upper digestive endoscopy, and circumferential fulguration of the mucosa surrounding the tube with pulsed argon plasma coagulation (APC) at 50 W and 1 L/min flow rate was performed. Additional long through-the-scope clips were applied in 2 cases, since the inner orifice remained enlarged, in order to obtain a better closure. Complete leakage and skin changes resolution occurred between 2 and 6 weeks after the procedure (mean 3.5 weeks). The overall mean follow-up was 19 months after the endoscopic procedure (maximum 30 months, minimum 10 months). There was no recurrence of leakage. <b><i>Conclusion:</i></b> The use of APC alone or combined with long through-the-scope clips in large internal stoma orifice resolved persistent leakage from percutaneous endoscopic gastrostomy in all 4 presented cases without complications. In our case series, this technique appeared to be an effective, safe, and relatively low-cost alternative to the treatment of persistent peristomal leakage of the mature gastrostomy tract.

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