Combined tracheostomy and percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy is rapidly becoming the preferred method of long-term enteral access with minimal complications obviating the need for prolonged nasogastric or orogastric intubation. Tracheostomy is the accepted technique for long-term airway control, especially for protection against upper airway secretions and respiratory failure. Over a 14 month period, 73 percutaneous gastrostomies were inserted in 71 patients. Nine patients (12.6 percent) had previously undergone tracheostomy, and 13 patients (18.3 percent) underwent a percutaneous endoscopic gastrostomy immediately after tracheostomy. All procedures were performed under local anesthesia. The concomitant percutaneous endoscopic gastrostomy added little time to the total procedure and was not associated with additional complications. Early experience with percutaneous gastrostomy indicates that a substantial number of patients (30.9 percent in the present study) also required tracheostomy. The tracheostomy and percutaneous endoscopic gastrostomy combination completely frees the nasopharynx of indwelling tubes. Concomitant percutaneous gastrostomy should be considered in patients undergoing tracheostomy.