Vui H C, Lim W C, Law H L, Norwani B, Charles V U
Raja Isteri Pengiran Anak Saleha Hospital, Department of Medicine, Jalan Tutong, Bandar Seri Begawan, Brunei Muara BA 1710 Brunei Darussalam.
Tan Tock Seng Hospital, Department of Gastroenterology.
Med J Malaysia. 2013 Oct;68(5):389-92.
Percutaneous endoscopic gastrostomy (PEG) placement in patients with ventriculo-peritoneal shunt (VPS) may be associated with complications. This study reports our experience of PEG in patients with VPS.
Consecutive patients undergoing PEG insertion in a gastroenterology unit over 18 month's period were retrospectively analyzed. All patients were evaluated by an attending gastroenterologist for fitness for procedure. Instructions were given for routine antibiotic prophylaxes before the procedure and continued for 48 hours. Patients were followed for immediate complications in particular, wound infection, signs of meningitis, deterioration in neurological state and shunt malfunction. Post discharge, patients were given routine follow-up for review.
Of 86 patients who had PEG inserted during the study period, 14 had VPS including 2 of which had VPS after PEG. The main common indications for VPS were intracerebral bleed and head trauma and for PEG were requirement of long term enteral feeding. Twelve patients had PEG at a mean interval of 61 days (range 1-187 days) after VPS. Of these, eight received prophylactic antibiotic or were on antibiotic for other indications before PEG. Two patients developed mild PEG site infections within a week of insertions, including one patient who was not given antibiotic prophylaxis, both treated successfully with antibiotics. The latter patient developed worsening hydrocephalus secondary to VPS blockage. At a mean follow-up period was 140 days (range 20-570 days), there were no death or further complications encountered.
Although safe in the majority of patients with VPS, PEG infection can lead to intracranial complications. We recommend antibiotic prophylaxis for VPS patients before PEG.
在脑室腹腔分流术（VPS）患者中进行经皮内镜下胃造口术（PEG）可能会出现并发症。本研究报告了我们在VPS患者中进行PEG的经验。
回顾性分析在18个月期间于胃肠病科接受PEG插入术的连续患者。所有患者均由主治胃肠病医生评估是否适合该手术。术前给予常规抗生素预防，并持续48小时。特别关注患者的即时并发症，尤其是伤口感染、脑膜炎体征、神经状态恶化和分流功能障碍。出院后，对患者进行常规随访复查。
在研究期间接受PEG插入术的86例患者中，14例有VPS，其中2例在PEG术后出现VPS。VPS的主要常见适应症是脑出血和头部外伤，PEG的主要常见适应症是长期肠内营养需求。12例患者在VPS后平均61天（范围1 - 187天）接受了PEG。其中，8例在PEG术前接受了预防性抗生素治疗或因其他适应症正在使用抗生素。2例患者在插入PEG后一周内发生轻度PEG部位感染，其中1例未接受抗生素预防，两者均用抗生素成功治疗。后一名患者因VPS堵塞继发脑积水加重。平均随访期为140天（范围20 - 570天），未出现死亡或进一步并发症。
尽管在大多数VPS患者中PEG是安全的，但PEG感染可导致颅内并发症。我们建议在PEG术前对VPS患者进行抗生素预防。
