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At least 19 recordsLinked to original sources
PubMedDate not supplied

Comparison of Foley catheter as a replacement gastrostomy tube with commercial replacement gastrostomy tube: a prospective randomized trial.

Percutaneous endoscopic gastrostomy (PEG) provides a non-surgical alternative to long-term enteral feeding. The gastrostomy tube, however, may deteriorate, malfunction, or be accidentally expelled, requiring replacement. A commercial gastrostomy tube is commonly used for replacement. However, a commercial replacement gastrostomy tube is many times more expensive than a Foley catheter, and the two have never been compared. We compared the efficacy and safety of an all-silicone Foley catheter used as a replacement feeding gastrostomy tube with the effectiveness of a commercial replacement gastrostomy tube in 46 patients undergoing long-term enteral feedings per gastrostomy. Twenty-four patients were randomized to the Foley group and 22 patients to the commercial replacement gastrostomy tube group. The Foley catheter functioned well without need for replacement in 16 (66%) patients for 27.4 +/- 14.8 (mean +/- SD) weeks; the commercial replacement gastrostomy tube functioned in 13 (59%) patients for 24.5 +/- 13.6 weeks (p > 0.05, NS). The Foley catheter needed to be replaced because of malfunction in 8 (34%) patients and the commercial replacement gastrostomy tube in 9 (41%) patients after 21.6 +/- 11.5 weeks and 19.3 +/- 9.3 weeks, respectively (p > 0.05, NS). Neither the Foley catheter nor the commercial replacement gastrostomy tube migrated; this was the most striking finding, in contrast to case reports in the literature. Our data suggest that the Foley catheter can be safely used as a replacement gastrostomy tube; it is considerably cheaper than the commercial replacement gastrostomy tube, and its efficacy and complication rates are similar to those of the commercial replacement gastrostomy tube.

Catheters, Indwelling↗
PubMed1986

Comparison of percutaneous endoscopic gastrostomy with surgical gastrostomy at a community hospital.

The results of percutaneous endoscopic gastrostomies in 100 patients in a community hospital were compared with those of surgically placed gastrostomies in 50 patients. The morbidity rate for the percutaneous endoscopic gastrostomy group was 4%, compared with 30% for the patients with surgically placed gastrostomies. The procedure-related mortality for percutaneous endoscopic gastrostomy was 1%, compared with 16% for surgically placed gastrostomies. Patients admitted to the hospital for percutaneous endoscopic gastrostomy stayed an average of 4 days compared with 10 days for the surgical patients; 14 patients had the percutaneous endoscopic gastrostomy performed as an outpatient procedure. There were no complications in this group, suggesting that percutaneous endoscopic gastrostomy can be safely performed as an outpatient. In this community hospital, percutaneous endoscopic gastrostomy was both substantially safer and far less expensive than surgically placed gastrostomy.

Aged↗
PubMedDate not supplied

Gastrostomy button placement through percutaneous gastrostomy tracts created with fluoroscopic guidance: experience in 27 children.

PURPOSE: The authors report their experience with skin level (button) gastrostomy placement through radiologically created gastrostomy tracts. PATIENTS AND METHODS: Fifty-two gastrostomy buttons have been placed in 27 children (average age, 73 months; range, 9-235 months). All buttons were placed through tracts created during earlier fluoroscopically guided percutaneous gastrostomy. Fifteen Bard mushroom-type buttons and 12 MIC-Key balloon-type buttons were initially placed. Patients have been followed up for an average of 13.4 months. RESULTS: Button placement was successful at the initial attempt in 25 of 27 patients (93%). Tract age at button placement averaged 18.5 weeks. The average tract length measured 3.5 cm (1.7-6.0 cm). Tract rupture and peritoneal leakage occurred in three patients; one patient had the button immediately repositioned without sequela, and the remaining two patients underwent replacement of the gastrostomy tube into the stomach and successful button placement approximately 1 week later. There were no major complications. Minor problems (leak, granulation tissue, valve malfunction, balloon breakage) occurred in 19 patients. CONCLUSION: Button gastrostomy is a useful alternative to the traditional gastrostomy tube for the pediatric population. Conversion with use of existing radiologically created tracts is possible and safe. Attention to tract integrity and proper button position is required to avoid complications.

Adolescent↗
PubMed1990

Combined endoscopic and surgical gastrostomy when percutaneous endoscopic gastrostomy is contraindicated.

The resurgence of enteral feeding, as both a more physiologic and cost-effective means of alimenting patients, has coincided with the increased popularity of endoscopically placed gastrostomies. Indeed, numerous retrospective studies have shown that percutaneous endoscopic gastrostomy (PEG) is superior to its surgical counterpart. There are, however, both absolute and relative contraindications to percutaneous placement. Reported here are three patients who were poor surgical candidates, yet had contraindications to percutaneous placement. Described is a method of combined endoscopic and surgical placement under local anesthesia used successfully in these patients. General anesthesia and laparotomy were not required. A 2-cm incision with endoscopic guidance was used and the gastrostomy was placed under direct vision and secured with a gastric purse string and sutured to the abdominal wall. There was no morbidity or mortality among the three cases reported. All gastrostomies were considered functional within 48 hrs. The authors feel this method is an excellent alternative when PEG is contraindicated. In addition, it may represent the safest and most effective method of gastrostomy placement in the majority of patients requiring a gastrostomy.

Adult↗
PubMed1994

A method for radiologic-assisted gastrostomy when percutaneous endoscopic gastrostomy is contraindicated.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) has been established as a faster and safer procedure than open surgical gastrostomy. It cannot be done, however, for many patients with partially obstructing pharyngeal or esophageal carcinoma, previous gastrectomy, upper abdominal surgery, or bowel distension from distal obstruction. PATIENTS AND METHODS: We attempted percutaneous radiologic-assisted gastrostomy (RAG) in 231 patients referred for gastrostomy, 38 of whom had a relative contraindication for PEG. The procedure involves passing, under radiologic guidance, an orogastric inflation tube that contains a snare. We used a 5-inch long, 18-gauge needle to transabdominally insert a wire into the stomach, avoiding loops of bowel visualized by air contrast. Retrieving the transabdominal wire by snare allowed retrograde passage of the gastrostomy tube as done in standard PEG. RESULTS: The procedure was successful in 230 of 231 cases, including 37 of the 38 patients with contraindications. We could not gain gastric access in 1 patient with a 75% gastrectomy. Overall, 6 patients developed complications and 1 died. There was no procedure-related morbidity or mortality in the patients with contraindications to PEG who underwent successful RAG. Subsequent laparotomy indicated tube passage through the liver in 2 of these cases and small bowel mesentery in 1 case without clinical problems. We performed a percutaneous jejunostomy in the efferent limb of the gastrojejunostomy in 1 patient with a previous gastrectomy. CONCLUSION: The snare technique is simpler and faster than the usual radiologic gastropexy technique, and safer than an endoscopic procedure. It has become our procedure of choice for gaining gastric access.

Adolescent↗
PubMed1988

Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy.

In a review of 125 percutaneous endoscopic gastrostomies (PEG) and 88 Stamm gastrostomies performed at Duke University Medical Center since 1978, the average operating room time for PEG (50 +/- 20 min) was shorter than for Stamm (96 +/- 26 min) (p less than 0.0001). General anesthesia was administered in only 13% of PEG placements compared with 64% of Stamm gastrostomies. The cost of PEG was about $1000 less than for Stamm gastrostomies. The average time after surgery until use of the feeding tube was 1.8 days for PEG compared with 3.4 days for Stamm (p less than 0.0001). The overall complication rate after PEG was 8.8% (4.0% major) compared with 23.9% for Stamm gastrostomies (10.2% major) (p less than 0.005). PEG reduces operative time, necessity for general anesthesia, expense of insertion, incidence of complications, and requires less recovery time before use. PEG is the procedure of choice for gastric feeding access.

Anesthesia, General↗
PubMed1996

Laparoscopic gastrostomy versus open gastrostomy in head and neck cancer patients.

Alimentation in the surgically treated head and neck cancer patient frequently requires bypassing the upper aerodigestive tract. The laparoscopic gastrostomy fulfills this criterion. The authors compared 25 laparoscopic gastrostomies (group 1) with 18 open gastrostomies (group 2) performed on head and neck cancer patients. The length of operation, morbidity, mortality, and cost were evaluated. Operative time was significantly shorter in group 1 (40 +/- 2 minutes) than in group 2 (56 +/- 4 minutes), with P=.003. The major complication rate was 9% for group 1 and 11% for group 2. There was no procedure-related mortality in group 1, but 1 patient died in the immediate postoperative period in group 2. The cost was not significantly different. It is concluded that the laparoscopic gastrostomy is a safe and cost-effective alternative to open gastrostomy in this patient group.

Anesthesia, General↗
PubMed1994

Laparoscopic gastrostomy versus percutaneous endoscopic gastrostomy. A comparison.

A retrospective study was carried out at our institution to compare patients who underwent percutaneous endoscopic gastrostomy (PEG) to those who underwent laparoscopic gastrostomy (LG). There were 17 patients who had a PEG with a mean age of 81 years (43-97 years). The procedure time, including complete esophago-gastroduodenoscopy, averaged 28 min. There were four deaths (23%) in a 30-day period, but none of these were directly related to the procedure. The LG group consisted of 14 patients with a mean age of 66 years (20-94 years). Mean duration of the procedure was 18 minutes. Thirty-day mortality rate was 35% (five patients) with one death (7%) directly related to the tube. Indications for gastrostomy were similar in both groups, being predominantly inability to eat and/or recurrent aspiration. However, LG was done because of 4 technical failures, 5 patients with tumors of the head and neck, 2 patients with esophageal obstruction and radiation stenosis precluding safe PEG, and 1 patient with hiatal hernia; 2 LGs were performed at the surgeon's preference. Outcomes for LG and PEG were comparable. LG is a suitable, safe alternative to PEG in selected patients who cannot undergo gastroscopy and should be considered the procedure of choice in patients with head and neck tumors or intrathoracic pathology that prevents PEG.

Adult↗
PubMed1995

Metastasis of hypopharyngeal carcinoma into the gastrostomy tract after placement of a percutaneous endoscopic gastrostomy catheter.

Percutaneous endoscopic gastrostomy catheters are frequently placed in patients with pharyngeal tumors. In this article, we report a patient with a metastasis of a large hypopharyngeal carcinoma in the gastrostomy tract, probably caused by placement of a percutaneous endoscopic gastrostomy catheter by the pull method. The metastasis decreased considerably in size after high-dose radiation therapy (as had the original hypopharyngeal tumor). The patient subsequently had a curative resection of the residual metastatic tumor, but one month after the operation he died of a cerebrovascular accident.

Abdominal Muscles↗
PubMed1997

[Computer tomography-guided gastrostomy, jejunostomy and gastrojejunostomy. A reliable non-surgical method also for contraindications and failure of percutaneous endoscopic gastrostomy].

OBJECTIVE: To analyse retrospectively the results of CT (computed tomography)-guided gastrostomy or gastroenterostomy where an endoscopic procedure was not possible or had failed. PATIENTS AND METHODS: Between August 1993 and March 1997, CT-guided gastrostomy (n = 50) or gastroenterostomy (n = 8) was performed in 58 patients (mean age 56 +/- 6 years; 51 males, 7 females). An endoscopic or fluoroscopic method had been contraindicated in 52 and had failed in 6 patients. RESULTS: Technical success was achieved in all patients. Three patients needed intravenous sedation. There were no procedure related complications requiring treatment. Three patients had a mild infection at the site of the skin puncture. CONCLUSION: CT-guided gastrostomy or gastroenterostomy is a safe and simple procedure which provides a minimally invasive alternative also in patients with contraindications to the established percutaneous method.

Adult↗
PubMed1991

The technique of percutaneous endoscopic gastrostomy. A safe and cost-effective alternative to operative gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) is an attractive method of providing enteral nutrition to patients who are candidates for operative gastrostomy or nasoenteric tube feeding; it is currently the procedure of choice for selected nutritionally compromised patients. PEG may be considered for patients who need short- or long-term enteral support; those unable to swallow or who cannot maintain adequate oral intake are ideal candidates. Several techniques are used to perform PEG; each involves the placement of a gastrostomy tube at a point where the stomach and abdominal walls are in closest contact. PEG can be done at the bedside without general anesthesia. Feeding can begin within 24 hours of PEG placement. Major complications (peritonitis and pulmonary aspiration) occur infrequently.

Contraindications↗
PubMedDate not supplied

[Percutaneous endoscopic gastrostomy in patients with head and neck neoplasms. Evaluation of a new gastrostomy].

Since their aparition in 1980, percutaneus endoscopic gastrostomy (PEG), represented a dramatic impact in the enteral nutrition thecnics and their indication have expanded. The PEG have many advantages over the surgical gastrostomy. In this paper, we present our experience with the use of PEG in patients with head and neck cancer using a new home made gastrostome. Included were 61 patients 37 males (64.8%), 21 females (36.2%) with ages betwen 11 and 72 years. In 3 patients the PEG was not intended because tight esophageal stenoses. The PEG was completed in 56 cases (91.8%). In 5 patients (8.6%) there were minor complications (4 infections and 1 patient with pain). We have only one case of major complication which consisted in migration of gastrotome to the abdominal wall (Buried Bumper Syndrome). The gastrostome was patent between 15 and 312 days with a median of 125 days. The gastrostomies was made with siliconed 22Fr Foley catheter, crazy glue, and plastic tops. The Foley catheter is acid resistant and not deteriorate like other materials like latex. There was not adverse reaction at the ostomy site. The cost of the kit is about 11 US$ and the commercial kit is 125 US$, on the other hand the internal diameter is 15% wider than the commercial one.

Adolescent↗
PubMed1984

Percutaneous endoscopic gastrostomy: a preferred method of feeding tube gastrostomy.

Percutaneous endoscopic gastrostomy was attempted in 16 patients using local anesthesia and intravenous meperidine and diazepam sedation. The procedure was shown to be safe, easy to perform, and avoided the need for laparotomy. We suggest percutaneous endoscopic gastrostomy be the preferred route of alimentation in those patients requiring feeding gastrostomy.

Enteral Nutrition↗
PubMed1990

Comparison of operative gastrostomy with percutaneous endoscopic gastrostomy.

The purpose of this study was to review our experience with 83 operative gastrostomies (OG) and 51 percutaneous endoscopic gastrostomies (PEG) and assess the advantage of one procedure over the other. The overall complication rate for the OG group was 30% with three cases of gastrocutaneous fistula. The overall complication rate for the PEG group was 24%. The 30-day mortality for OG was 7% and for PEG, 10%. We conclude that both OG and PEG are effective methods of enteral access. No gastrocutaneous fistulas developed in patients who underwent PEG. In our experience, no statistically significant difference was noted in morbidity and mortality of either group.

Adult↗
PubMed1995

Utilization and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: a population-based study.

OBJECTIVE: To determine the indications for use of surgical gastrostomy (SG) and surgical jejunostomy (SJ) as feeding tubes, the complications, and the trends in the use of SG and SJ after the introduction of percutaneous endoscopic gastrostomy (PEG) at our institution in 1981. DESIGN: We conducted a retrospective, population-based cohort study of residents of Olmsted County, Minnesota, who received surgically placed feeding tubes between 1976 and 1989. MATERIAL AND METHODS: The medical records of all Olmsted County residents with surgical placement of a feeding tube during the designated study period were reviewed, and underlying conditions, complications, and survival were analyzed. RESULTS: Of 77 adult patients (mean age, 66 years; 48% women), 54 underwent SG and 23 had SJ. General anesthesia was used in 42 patients (55%). The indications for SG or SJ were stroke in 23 patients, cancer in 19, other central nervous system-related conditions in 16, and other conditions in 19. Among the numerous comorbid conditions, pulmonary disease (N = 44) and cardiac disease (N = 32) were most frequent. The median duration of follow-up was 181 days. Complications occurred in 31 of 54 patients (57%) with SG and in 13 of 23 (57%) with SJ. Of the 117 complications, 15% were considered major. Twenty patients (26%) resumed eating. Survival at 1, 6, and 12 months was 79%, 49% and 36%, respectively. Most deaths were due to the disease for which the feeding tube had been placed. In a Cox proportional hazards regression analysis, only age and hypoxemia were found to be significantly associated with survival. Hypoxemia, type of tube, central nervous system disease as indication for procedure, and previous aspiration were associated with failure to resume eating (P < 0.05). Survival was similar to that for our patients with PEG during the same period. The overall incidence of feeding tube placement increased throughout the study period. CONCLUSION: Patients who require enteral feeding tubes have multiple comorbid conditions that have a major influence on the outcome. The overall incidence of feeding tube placement increased after the introduction of PEG. In patients who require long-term enteral nutrition and are unable to have a feeding tube placed percutaneously, surgically placed feeding tubes have outcomes similar to those reported for patients with PEG.

Aged↗
PubMed1997

[Laparoscopic gastrostomy--advantages in comparison with percutaneous endoscopic gastrostomy (PEG)].

Laparoscopic gastrostomy was performed on 70 patients with contraindications to PEG. All procedures were performed successfully, even in patients with gastric resections, after gallbladder surgery, and in patients with liver cirrhosis and ascites. Long-term results comprise a low complication rate of 0.12 in 100 application days. Laparoscopic gastrostomy is a highly effective procedure with low morbidity and good long-term results in patients with contraindications to PEG requiring enteral feeding.

Adult↗