Öz
AMAÇ
Perkütan endoskopik gastrostomi (PEG), uzun süreli enteral nütrisyon gerektiren gastrointestinal sistemi aktif olan hastalarda tercih edilen bir yoldur. Cerrahi bir müdahale olması sebebiyle hem akut hem de kronik dönemde komplikasyonlara neden olabilmektedir. Bu çalışmada, deneyimlerimizi ve kliniğimizde yapılan PEG işlemlerinden elde ettiğimiz verileri sunmayı amaçladık.
GEREÇ VE YÖNTEMLER
Sağlık Bilimleri Üniversitesi Konya Şehir Hastanesi Endoskopi Ünitesi’nde 1 Ocak 2008-31 Aralık 2020 tarihleri arasında PEG yapılan 386 hasta incelendi. İşlem sonrası hasta bilgileri kaydedildi. İlk 1 aylık dönemde PEG’e bağlı komplikasyonlar ve 6 aylık mortalite incelendi.
BULGULAR
Hastaların 26’sında (%6,7) kateter çıkış yerinde yara enfeksiyonu, 2’sinde (%0,5) cilt, cilatı seviyede kanama, 7’sinde (%1,8) kateter etrafından sızma, 18’inde (%4,6) çıkma, 6’sında (%1,5) tıkanma görülmüştür. PEG işlemi ile direkt ilişkili, işlem sırası ve yakın dönemde mortalite gözlenmemiştir. 47 (%12) hasta ilk 1 hafta içinde, 113 (%29) hasta ilk 1 ay içinde, 192 (%49) hasta 6 ay içinde ölmüştür. İkiden çok sistemik hastalığı olanlarda 1 aylık mortalite oranı %44 olarak tespit edilmiştir.
SONUÇLAR
Komplikasyon oranlarının düşürülebilmesi için PEG yapılan hastalarda enfeksiyon ile etkin mücadele ve asepsi önerileri önemlidir. Ayrıca tüp tespiti dikkatli yapılmalı ve hasta yakınları ayrıntılı bilgilendirilmelidir.
Anahtar Kelimeler
Destekleyen Kurum
yok
Teşekkür
Çalışma esnasında verilerin istatistiksel analizindeki yardımlarından dolayı Dr.Alpaslan Şahin'e teşekkür ederiz.
Kaynakça
- 1. Dumlu E, Bozkurt B, Tokaç M, Kıyak G. Cerrahi Hastalarda Malnütrisyon ve Beslenme Desteği. Ankara Tıp Dergisi. 2013;(1)33-39
- 2. Vyawahare MA, Shirodkar M, Gharat A, Patil P, Mehta S, Mohandas KM. A comparative observational study of early versus delayed feding after percutaneous endoscopic gastrostomy. Indian J Gastroenterol 2013;32(6):366–8.
- 3. Conroy T. The Prevention and Management of Complications associated with established Percutaneous Gastrostomy Tubes in Adults: A Systematic Review. JBI Libr Syst Rev 2009 ;7(1):1–37.
- 4. Taylor Ca, Larson De, BallardDj, BergstromLr, Sılversteın Md, Zınsmeıster Ar, et al. Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study. Mayo Clin Proc 1992 67(11):1042–9.
- 5. Stiegmann G v., Goff JS, Silas D, Pearlman N, Sun J, Norton L. Endoscopic versus operative gastrostomy: final results of a prospective randomized trial. Gastrointest Endoscopy 1990 ;36(1):1–5.
- 6. Laskaratos FM, Walker M, Walker M, Gowribalan J, Gkotsi D, Wojciechowska V, et al. Predictive factors for early mortality after percutaneous endoscopic and radiologically-inserted gastrostomy. Dig Dis 2013;58(12):3558–65.
- 7. Ponsky JL, Gauderer MWL. Percutaneous endoscopic gastrostomy: a nonoperative technique for feding gastrostomy. Gastrointest Endosc 1981;27(1):9–11.
- 8. vanDyck E, Macken EJ, Roth B, Pelckmans PA, Moreels TG. Safety of pull-type and introducer percutaneous endoscopic gastrostomy tubes in oncology patients: a retrospective analysis. BMC Gastroenterol 2011;11,23
- 9. Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol 2012 ;47(6):737–42.
- 10. Demirci H, Kilciler G, Öztürk K, Kantarcıoğlu M, Uygun A, Bağcı S. Perkütan endoskopik gastrostomi uygulamalarındaki tecrübelerimiz. Endoskopi Gastrointestinal 2015 ;23(3):73–6.
- 11. Akici M, Erşen O, Çelik G, Çilekar M, Experıences Wıth Percutaneous Endoscopıc Gastrostomy In A General Surgery Clınıc. SDÜ Tıp Fakültesi Dergisi 2019 ;26(3):234–8.
- 12. Debra L. Malone, Thomas Genuit, J.Kathleen Tracy, Christopher Gannon, Lena M. Napolitano, Surgical Site Infections: Reanalysis of Risk Factors, Journal of Surgical Research, Volume 103, Issue 1, 2002
- 13. Çakır M, Tekin A, Küçükkartallar T, Çiftçi İ, Vatansev C, Aksoy F, et al. Endoscopic gastrostomy Dicle Tıp Derg. Dicle Med J 2012 ;39(2):162–5.
- 14. Blomberg J, Lagergren P, Martin L, Mattsson F, Lagergren J. Novel approach to antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): randomised controlled trial. BMJ. 2010 ;341(7763):81
Öz
AIM
Percutaneous endoscopic gastrostomy (PEG) is the preferred route in patients with active gastrointestinal tract who require long-term enteral nutrition. Since it is a surgical intervention, it can cause complications in both acute and chronic periods. In this study, we aimed to present our experience and the data we obtained from PEG procedures performed in our clinic.
MATERIALS AND METHODS
386 patients who underwent PEG between January 1, 2008 and December 31, 2020 in the Endoscopy Unit of the Health Sciences University Konya City Hospital were examined. Patient information was recorded after the procedure. Complications related to PEG in the first 1-month period and 6-month mortality were evaluated.
RESULTS
Wound infection at the catheter exit site in 26 (6.7%) patients, skin and lacquer bleeding in 2 (0.5%), leakage around the catheter in 7 (1.8%), 18 (4%) patients , 6% had protrusion, and 6 (1.5%) had occlusion. No mortality was observed directly related to the PEG procedure, during the procedure and in the recent period. 47 (12%) patients died within the first week, 113 (29%) patients died within the first 1 month, and 192 (49%) patients died within 6 months. In patients with more than two systemic diseases, the 1-month mortality rate was 44%.
RESULTS
In order to reduce the complication rates, effective control of infection and asepsis recommendations are important in patients undergoing PEG. In addition, tube detection should be done carefully and patient relatives should be informed in detail.
Anahtar Kelimeler
Kaynakça
- 1. Dumlu E, Bozkurt B, Tokaç M, Kıyak G. Cerrahi Hastalarda Malnütrisyon ve Beslenme Desteği. Ankara Tıp Dergisi. 2013;(1)33-39
- 2. Vyawahare MA, Shirodkar M, Gharat A, Patil P, Mehta S, Mohandas KM. A comparative observational study of early versus delayed feding after percutaneous endoscopic gastrostomy. Indian J Gastroenterol 2013;32(6):366–8.
- 3. Conroy T. The Prevention and Management of Complications associated with established Percutaneous Gastrostomy Tubes in Adults: A Systematic Review. JBI Libr Syst Rev 2009 ;7(1):1–37.
- 4. Taylor Ca, Larson De, BallardDj, BergstromLr, Sılversteın Md, Zınsmeıster Ar, et al. Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study. Mayo Clin Proc 1992 67(11):1042–9.
- 5. Stiegmann G v., Goff JS, Silas D, Pearlman N, Sun J, Norton L. Endoscopic versus operative gastrostomy: final results of a prospective randomized trial. Gastrointest Endoscopy 1990 ;36(1):1–5.
- 6. Laskaratos FM, Walker M, Walker M, Gowribalan J, Gkotsi D, Wojciechowska V, et al. Predictive factors for early mortality after percutaneous endoscopic and radiologically-inserted gastrostomy. Dig Dis 2013;58(12):3558–65.
- 7. Ponsky JL, Gauderer MWL. Percutaneous endoscopic gastrostomy: a nonoperative technique for feding gastrostomy. Gastrointest Endosc 1981;27(1):9–11.
- 8. vanDyck E, Macken EJ, Roth B, Pelckmans PA, Moreels TG. Safety of pull-type and introducer percutaneous endoscopic gastrostomy tubes in oncology patients: a retrospective analysis. BMC Gastroenterol 2011;11,23
- 9. Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol 2012 ;47(6):737–42.
- 10. Demirci H, Kilciler G, Öztürk K, Kantarcıoğlu M, Uygun A, Bağcı S. Perkütan endoskopik gastrostomi uygulamalarındaki tecrübelerimiz. Endoskopi Gastrointestinal 2015 ;23(3):73–6.
- 11. Akici M, Erşen O, Çelik G, Çilekar M, Experıences Wıth Percutaneous Endoscopıc Gastrostomy In A General Surgery Clınıc. SDÜ Tıp Fakültesi Dergisi 2019 ;26(3):234–8.
- 12. Debra L. Malone, Thomas Genuit, J.Kathleen Tracy, Christopher Gannon, Lena M. Napolitano, Surgical Site Infections: Reanalysis of Risk Factors, Journal of Surgical Research, Volume 103, Issue 1, 2002
- 13. Çakır M, Tekin A, Küçükkartallar T, Çiftçi İ, Vatansev C, Aksoy F, et al. Endoscopic gastrostomy Dicle Tıp Derg. Dicle Med J 2012 ;39(2):162–5.
- 14. Blomberg J, Lagergren P, Martin L, Mattsson F, Lagergren J. Novel approach to antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): randomised controlled trial. BMJ. 2010 ;341(7763):81
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 14 Sayı: 1 |
Kaynak Göster
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