Chang Wei-Kuo, Wang Ning-Chi, Wang Wei-Ming, Chen Jeng-Feng
Wei-Kuo Chang, MD, PhD, is a Gastroenterologist and Chief of Digestive Endoscopy, Division of Gastroenterology, Department of Internal Medicine; Ning-Chi Wang, MD, is an infectious disease specialist, Division of Infection, Department of Internal Medicine; Wei-Ming Wang, MD, PhD, is a Dermatologist and head of Department of Dermatology, Department of Dermatology; and Jeng-Feng Chen, MD, is a Consultant Dermatologist, Department of Dermatology; all at Tri-Service General Hospital, National Defense Medical Center, Taiwan, Republic of China.
Adv Skin Wound Care. 2014 Jun;27(6):260-7. doi: 10.1097/01.ASW.0000449854.63913.25.
Percutaneous endoscopic gastrostomy (PEG) is the most commonly used procedure in patients requiring long-term tube feeding. Lack of universal terminology and variations in the description of long-term PEG cutaneous lesions make it difficult for clinicians to interpret, communicate, and formulate a plan of treatment. The authors designed a prospective study to assess the long-term PEG cutaneous lesions and the healthcare utilization.
After the PEG procedure, patients followed up for more than 12 months were included. Results of physical examination of the PEG cutaneous lesions were recorded. Laboratory tests, including the standard urine strip test, which detected the presence of bilirubin, microbiologic culture, as well as computed tomography, were applied in patients with PEG long-term cutaneous complications. Unscheduled hospital visits also were recorded.
The mean follow-up duration after PEG was 28 ± 15 months. Among patients with long-term PEG, 33.6% of the patients had normal skin, 31.0% had skin erythema, 21.2% had wound discharge, 24.8% had granulation tissue, 15.0% had postinflammatory hyperpigmentation, 15.9% had scarring, 5.3% had side torsion, 29.2% had stoma retraction, and 5.3% had bulging lesions. Urine strip test can differentiate gastric content leakage from purulent exudate/serous fluid. All patients with bulging lesions required hospitalization.
Long-term PEG cutaneous problems are common. Appropriate physical examinations and laboratory tests can provide evidence to identify the causes, treat the patients with the PEG cutaneous problems, and decrease the risk for potential unscheduled hospital visits.
经皮内镜下胃造口术（PEG）是长期需要管饲患者最常用的手术。长期PEG皮肤病变缺乏通用术语且描述存在差异，这使得临床医生难以进行解释、沟通和制定治疗方案。作者设计了一项前瞻性研究，以评估长期PEG皮肤病变及医疗资源利用情况。
纳入PEG术后随访超过12个月的患者。记录PEG皮肤病变的体格检查结果。对于有PEG长期皮肤并发症的患者，进行实验室检查，包括检测胆红素的标准尿试纸条试验、微生物培养以及计算机断层扫描。还记录了非计划内的医院就诊情况。
PEG术后的平均随访时间为28±15个月。在长期PEG患者中，33.6%的患者皮肤正常，31.0%有皮肤红斑，21.2%有伤口渗液，24.8%有肉芽组织，15.0%有炎症后色素沉着，15.9%有瘢痕形成，5.3%有侧扭转，29.2%有造口回缩，5.3%有隆起性病变。尿试纸条试验可区分胃内容物漏出与脓性渗出物/浆液性液体。所有有隆起性病变的患者均需住院治疗。
长期PEG皮肤问题很常见。适当的体格检查和实验室检查可为确定病因、治疗PEG皮肤问题患者及降低潜在非计划内医院就诊风险提供依据。
