Ochsner Clinic Foundation, Department of Gastroenterology and Hepatology, New Orleans, LA 70121, USA.
Nutr Clin Pract. 2009 Dec;24(6):723-7. doi: 10.1177/0884533609349250.
Percutaneous endoscopic feeding tube placement is generally safe and effective for establishing enteral access. In certain subpopulations, such as obese patients, substantial data are limited. This study evaluates the success rate and potential for late complications with placement of feeding tubes in obese patients.
The Medical University of South Carolina endoscopy database was queried for adult patients with a body mass index >or=30 kg/m(2) who had undergone percutaneous endoscopic gastrostomy, percutaneous endoscopic gastrojejunostomy, and direct percutaneous jejunostomy placement procedures between the years 2000 and 2006.
Sixty-seven subjects met the inclusion criteria. Percutaneous endoscopic feeding tube placement was successful in 60 of 67 individuals (89.6%) with an average procedure time of 15.5 minutes (range, 5-70 minutes). Postplacement complications occurred in 26 of 59 subjects (44.1%) and included peristomal pain (8.5%), cellulitis (8.5%), inadvertent removal (6.8%), peritubular leak (6.8%), nausea (3.4%), and hemoperitoneum (3.4%). In multivariable logistic regression analysis, weight >250 pounds (>113 kg) predicted a significantly increased likelihood of complications (adjusted odds ratio = 3.86; 95% confidence interval, 1.02-14.57). Other covariates did not significantly affect the complication rate.
Percutaneous enteral access device placement in obese patients is generally safe, and a body mass index >or=30 kg/m(2) alone should not be a procedural contraindication. Adherence to safe enteral access placement techniques and close periprocedure follow-up should occur in obese patients, especially those weighing >250 pounds (>113 kg). More research is needed to fully evaluate the efficacy of enteral access in this population.
经皮内镜下置管术通常是安全有效的肠内营养途径。但在某些特定人群中，如肥胖患者，相关数据非常有限。本研究旨在评估经皮内镜下置管术在肥胖患者中的成功率和迟发性并发症的发生情况。
本研究检索了 2000 年至 2006 年期间在南卡罗来纳医科大学内镜数据库中，BMI≥30kg/m²的接受经皮内镜下胃造口术、经皮内镜下胃肠吻合术和直接经皮空肠造口术的成年患者的资料。
67 例患者符合纳入标准。67 例患者中 60 例（89.6%）置管成功，平均手术时间为 15.5 分钟（5-70 分钟）。59 例患者中有 26 例（44.1%）发生了置管后并发症，包括造口周围疼痛（8.5%）、蜂窝织炎（8.5%）、意外拔管（6.8%）、管周漏（6.8%）、恶心（3.4%）和腹腔积血（3.4%）。多变量逻辑回归分析显示，体重>250 磅（>113kg）显著增加了并发症的发生风险（调整后的优势比=3.86；95%可信区间，1.02-14.57）。其他协变量对并发症发生率无显著影响。
在肥胖患者中进行经皮肠内营养途径置管术一般是安全的，单纯 BMI≥30kg/m²不应该成为手术的禁忌证。对于肥胖患者，特别是体重>250 磅（>113kg）的患者，应严格遵循安全的肠内营养途径置管技术，并密切随访。还需要进一步研究以充分评估该人群肠内营养途径的疗效。
