Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA.
J Intensive Care Med. 2020 Sep;35(9):851-857. doi: 10.1177/0885066618800275. Epub 2018 Sep 24.
Percutaneous endoscopic gastrostomy (PEG) tube placement is a procedure frequently done in the intensive care unit. The use of a traditional endoscope can be difficult in cases of esophageal stenosis and theoretically confers an increased risk of infection due to its complex architecture. We describe a technique using the bronchoscope, which allows navigation through stenotic esophageal lesions and also minimizes the risk of endoscopy-associated infections.
Prospective series of patients who had PEG tube placement guided by a bronchoscope. Procedural outcomes including successful placement, duration of the entire procedure, time needed for passage of the bronchoscope from the oropharynx to the major curvature, PEG tube removal rate, and mortality were collected. Procedural adverse events, including infections and long-term PEG-related complications, were recorded.
A total of 84 patients underwent bronchoscope-guided PEG tube placement. Percutaneous endoscopic gastrostomy tube insertion was completed successfully in 82 (97.6%) patients. Percutaneous endoscopic gastrostomy tube placement was performed immediately following percutaneous tracheostomy in 82.1%. Thirty-day mortality and 1-year mortality were 11.9% and 31%, respectively. Overall, minor complications occurred in 2.4% of patients, while there were no major complications. No serious infectious complications were identified and no endoscope-associated hospital acquired infections were documented.
The use of the bronchoscope can be safely and effectively used for PEG tube placement. The use of bronchoscope rather than a gastroscope has several advantages, which include the ease of navigating through complex aerodigestive disorders such as strictures and fistulas as well as decreased health-care utilization. In addition, it may have a theoretical advantage of minimizing infections related to complex endoscopes.
经皮内镜胃造口术（PEG）管放置是重症监护病房中经常进行的一项操作。在食管狭窄的情况下，使用传统内镜可能会很困难，并且由于其复杂的结构，理论上会增加感染的风险。我们描述了一种使用支气管镜的技术，该技术允许通过狭窄的食管病变进行导航，并且还最大限度地降低了与内镜相关的感染风险。
前瞻性系列患者，他们通过支气管镜引导进行 PEG 管放置。收集了包括成功放置、整个手术过程的持续时间、支气管镜从口咽部到达大曲率所需的时间、PEG 管移除率和死亡率在内的手术结果。记录了与手术相关的不良事件，包括感染和长期 PEG 相关并发症。
共有 84 名患者接受了支气管镜引导的 PEG 管放置。82 名（97.6%）患者成功完成了经皮内镜胃造口术管插入。82.1%的患者在经皮气管切开术后立即进行了经皮内镜胃造口术。30 天死亡率和 1 年死亡率分别为 11.9%和 31%。总体而言，2.4%的患者发生轻微并发症，无重大并发症。未发现严重感染并发症，也未记录与内镜相关的医院获得性感染。
支气管镜可安全有效地用于 PEG 管放置。与使用胃镜相比，使用支气管镜具有几个优点，包括更容易通过复杂的呼吸道和消化道疾病（如狭窄和瘘管）进行导航，以及减少医疗保健的利用。此外，它可能具有理论上的优势，可以最大程度地减少与复杂内镜相关的感染。
