Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Surg Endosc. 2012 Dec;26(12):3541-7. doi: 10.1007/s00464-012-2348-7. Epub 2012 May 31.
Despite technical refinements of percutaneous endoscopic gastrostomy (PEG) tube placement, complications such as early tube dislodgement remain relatively static. This study aimed to review the experience of a high-volume endoscopy center after the introduction of T-fastener placement in high-risk patients.
The authors retrospectively reviewed PEG placement from October 2010 to September 2011, when their group began to use T-fasteners selectively in high-risk patients. Patients deemed to have an increased risk for early tube dislodgement underwent T-fastener placement at the time of PEG placement. Patients with PEG alone were compared with patients who had PEG with T-fastener (PEG-T) placement. Statistical analysis was performed using SPSS version 18.
During the study period, 195 patients underwent PEG placement. For 121 patients, PEG alone was performed, whereas PEG-T was performed for 74 patients. Six patients had tube dislodgement (five early, one late) in the PEG-T cohort versus none in the PEG-alone cohort (P = 0.003). The first patient underwent diagnostic laparoscopy with replacement gastrostomy 2 days after tube dislodgement and was noted to have no contamination, with direct apposition of the stomach to the abdominal wall from the T-fasteners. The subsequent four patients with early tube dislodgement underwent non-emergent PEG replacement in the endoscopy unit within 24 h after tube dislodgement. In the short-term follow-up period, no repeat dislodgements were noted. Early mortality in the entire cohort was experienced by 38 (19.5%) of the 195 patients.
Placement of T-fasteners in high-risk patients may decrease overall morbidity if early tube dislodgement occurs. The findings show the safety of non-emergent endoscopic replacement of PEGs in certain patients. Early tube dislodgement may be a marker of overall mortality.
尽管经皮内镜胃造口术（PEG）管放置技术不断完善，但并发症（如早期管脱落）仍相对稳定。本研究旨在回顾一家高容量内镜中心在引入 T 型紧固件后在高危患者中应用的经验。
作者回顾性分析了 2010 年 10 月至 2011 年 9 月期间的 PEG 放置情况，当时他们的团队开始在高危患者中选择性地使用 T 型紧固件。有早期管脱落风险增加的患者在进行 PEG 放置时进行 T 型紧固件放置。将接受 PEG 治疗的患者与接受 PEG-T 治疗的患者进行比较。使用 SPSS 版本 18 进行统计分析。
在研究期间，195 例患者接受了 PEG 放置。121 例患者仅行 PEG，74 例患者行 PEG-T。PEG-T 组中有 6 例患者（5 例早期，1 例晚期）发生管脱落，而 PEG 组中无一例发生管脱落（P = 0.003）。第一例患者在管脱落 2 天后接受诊断性腹腔镜检查和更换胃造口术，发现无感染，T 型紧固件直接将胃贴合于腹壁。随后 4 例早期管脱落患者在管脱落 24 小时内行非紧急性 PEG 更换。在短期随访期间，未再发生管脱落。195 例患者中，共有 38 例（19.5%）患者发生早期死亡。
如果发生早期管脱落，在高危患者中放置 T 型紧固件可能会降低整体发病率。研究结果表明，在某些患者中，非紧急性内镜更换 PEG 是安全的。早期管脱落可能是总死亡率的一个标志。
