EXPERIENCES WITH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN A GENERAL SURGERY CLINIC

ÖZGÜN ARAŞTIRMA ORIGINAL RESEARCH Med J SDU / SDÜ Tıp Fak Derg u 2019:26(3):234-238 doi: 10.17343/sdutfd.532154 EXPERIENCES WITH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN A GENERAL SURGERY CLINIC BİR GENEL CERRAHİ KLİNİĞİNDE PERKÜTAN ENDOSKOPİK GASTROSTOMİ DENEYIMLERI Murat AKICI1, Ogün ERŞEN2 , Girayhan ÇELIK3, Murat ÇILEKAR1 1. Afyon Sağlık Bilimleri Üniversitesi Hastanesi Genel Cerrahi A.D 2. Ankara Üniversitesi Tıp Fakültesi Genel Cerrahi A.D 3. Isparta Şehir Hastanesi Genel Cerrahi Kliniği Cite this article as:Akıcı M, Erşen O, Çelik G, Çilekar M. Experıences Wıth Percutaneous Endoscopıc Gastrostomy In A General Surgery Clınıc. Med J SDU 2019; 26(3): 234-238. Öz Amaç Çalışmamızda perkutan endoskopik gastrostomi uyguladığımız hastaların retrospektif bakısında bulduğumuz sonuçları ve edindiğimiz tecrübeleri sunmayı amaçladık. Gereç ve Yöntem 01 Ocak 2008-31 Aralık 2017 tarihleri arasında Afyonkarahisar Sağlık Bilimleri Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği Endoskopi Ünitesinde ve hasta yatağı başında perkutan endoskopik gastrostomi tüpü takılan 378 hasta çalışmaya alındı. Hasta kayıtları dosya tarama yöntemiyle incelendi. Kayıtlar demografik bilgiler, teknik bilgiler, endikasyon, komplikasyon ve sonuçlar açsından değerlendirildi. Bulgular PEG kateteri takılan toplam 378 hastanın 230’u (%60,9) erkek, 148’i (%39,1) ise kadındı. Tüm hastaların ortalama yaşı 73,4±2 (20-93) idi. Hastaların 244’ünde (%64,5) nörolojik nedenlere bağlı yutma bozukluğu mevcut iken 98’inde (%26) ise mekanik nedenlere bağlı yutma bozukluğu sebebiyle PEG işlemi uygulanmıştı. 36 hastada (%9,5) ise cerrahi nedenlerle diversiyon için PEG kateteri açılmıştır. İşlem sonrası hiçbir hastada işlem nedenli mortalite veya major komplikasyon gözlenmedi. Gastrostomi kateterinin tespit edildiği seviyeye göre ciltalt yağ dokusu fazla olan hastalarda yara yeri enfeksiyonu oranı anlamlı olarak fazla tespit edildi. Komplikasyon gelişme riski altmış yaş üstünde hastalarda daha yüksek saptandı (p=0,038). Sonuç Bir genel cerrahi kliniğinde peg kateteri takılması işlemi cerrahi veya medikal hastalıkları bulunan hastalara literatürdeki komplikasyon ve başarı oranları ile uyumlu olarak uygulanmaktadır. Anahtar Kelimeler: Perkutan endoskopik gastrostomi, gastrostomi, disfaji Abstract Objective In our study, we aimed to present the results of our experiences and the results we detected in the retrospective examination of patients undergoing percutaneous endoscopic gastrostomy. Material and Method 378 patients in whom percutaneous endoscopic gastrostomy tube were placed at the patient’s bedside in Afyon Kocatepe University of Health Sciences, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 1, 2008 and De- İletişim kurulacak yazar/Corresponding author: Müracaat tarihi/Application Date: 25.02.2019 • Kabul tarihi/Accepted Date: 12.04.2019 Available online at http://dergipark.gov.tr/sdutfd Makaleye http://dergipark.gov.tr/sdutfd web sayfasından ulaşılabilir. t 234 Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi cember 31, 2017 were included in the study. Patient records were examined by the file scanning methods. The records were evaluated in terms of demographic information, technical information, indications, complications and results. Results Of a total of 378 patients in whom PEG catheter was placed, 230 (60.9%) were male and 148 (39.1%) were female. The mean age of all patients was 73.4 ± 2 (2093). While 244 (64.5%) of the patients had swallowing disorder due to neurological causes, PEG procedure was performed in 98 (26%) due to swallowing disorder caused by mechanical reasons. In 36 patients (9.5%) PEG catheter was opened for diversion due to surgical reasons. No procedure-related mortality or Introduction It is known that nutritional status causes damage to the healing process with the formation of postoperative complications in surgical patients, and causes an increase in health care costs and infections in patients undergoing medical treatment(1,2,3). Enteral nutrition is also important for the maintenance of the barrier functions of the gastrointestinal mucosa and intestinal immune response and also for the continuation of the flora (4,5). The placement of the gastrostomy tube aided by percutaneous endoscopy was first performed in the pediatric patient group by Ponsky and Gauderer in 1980 (6). In comparison to the gastrostomies opened by surgical methods, percutaneous endoscopic gastrostomies are performed as gold standard today for the continuation of enteral nutrition due to the fact that their method is more simple, comfortable and with a low complication rate. To be performed especially by using local anaesthetics without requiring general anesthesia provides a significant advantage over open gastrostomy methods. PEG indications include dysphagia caused by neurological diseases, long-term coma, and though rare, mechanical obstruction of the lingual, laryngopharyngeal and esophageal regions. In dieases progressing with mechanical obstruction, since the obstruction does not generally preclude the need to open gastrostomy without fully preventing food intake, endoscopic procedures in this last patient group may fail due to the fact that the scope cannot pass into the distal in general. Open gastrostomies may have to be performed in this patient group. In addition, gastrostomy is also opened for diversion purposes for duodenal injuries, esophageal injuries and anastomosis safety. In this study, we t 235 Experıences wıth Percutaneous Endoscopıc Gastrostomy major complication was observed in any patient after the procedure. The rate of wound infection was determined to be significantly higher in patients with high subcutaneous adipose tissue when compared to the level at which the gastrostomy catheter was detected. The risk of complication development was detected higher in patients over the age of sixty (p = 0.038). Conclusion In a general surgical clinic, peg catheter placement procedure is performed in patients with surgical or medical diseases in accordance with the complication and success rates in the literature. Keywords: Percutaneous endoscopic gastrostomy, gastrostomy, dysphagia aimed to present our experiences and the data we obtained from the PEG procedures performed by our clinic. Material And Method 378 patients in whom percutaneous endoscopic gastrostomy tube were placed at the patient’s bedside in Afyon Kocatepe University of Health Sciences, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 1, 2008 and December 31, 2017 were included in the study. Patient information recorded after the procedure and complications caused by gastrostomy catheter insertion during the first 1-month period were examined. Application Technique All PEG procedures were performed by using the pull method with oxygen support and monitorization under the supervision of anesthesiologists in our endoscopy unit or in intensive care uni (...truncated)