[Percutaneous endoscopic gastrostomy in the rehabilitation of neurological disorders].

Chronic enteric alimentation is preferred to parenteral nutritional support not only during intensive care but also during rehabilitation in severe neurologic disorders such as brain injury and high tetraplegia. As the long-term placement of nasogastric tubes has several disadvantages and undesirable side effects, we chose the nonoperative endoscopic technique for placement of a transdermal gastric feeding tube. PEG was performed in 40 patients with neurologic conditions associated with impaired swallowing or repeated aspiration problems: 20 patients with CNS trauma, 13 patients with high tetraplegia and 7 patients with severe neurologic disease of the CNS. The procedure used was that described by Gauderer and Ponsky. It was performed under local anesthesia in the majority of cases and under intravenous sedation in all cases. Technical problems practically did not occur, while minor complications were seen in 15% of the patients treated and major complications in 2.5%. Because of the high rate of peristomal wound infections despite systematic antibiotic prophylaxis, it was assumed that percutaneous infections could be secondary to contamination of the transcutaneous wound with oropharyngeal bacteria and local disinfection of the mouth with betadine has now been started before the procedure. Percutaneous endoscopic gastrostomy is a relatively safe (morbidity of less than 10%), very practical and cost-effective technique. It is well tolerated by the patients in whom swallowing mechanisms are impaired, affords advantages in regard to nursing care and should therefore belong to the standard therapeutic procedures in neurologic rehabilitation.