Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA.
Surg Endosc. 2022 Nov;36(11):8214-8220. doi: 10.1007/s00464-022-09262-2. Epub 2022 Apr 27.
Percutaneous endoscopic gastrostomy (PEG) tubes are placed by gastroenterologists (GI) and surgeons throughout the country. At Rhode Island Hospital, before July of 2017, all PEGs were placed by GI. In July of 2017, in response to a growing need for PEGs, acute care surgeons (ACS) also began performing PEGs at the bedside in ICUs. The purpose of this study was to review and compare outcomes of PEG tubes placed by ACS and GI.
Retrospective chart review of patients who received a PEG placed by ACS or GI at the bedside in any ICU from December 2016 to September 2019. Charts were reviewed for the following outcomes: Success rates of placing PEG, duration of procedure, major complications, and death. Secondary outcomes included discharge disposition, and rates of comfort measures only after PEG.
In 2017, 75% of PEGs were placed by GI and 25% surgery. In 2018, 47% were placed by GI and 53% by surgery. In 2019, 33% were placed by GI and 67% by surgery. There was no significant difference in success rates between surgery (146/156 93.6%) and GI (173/185 93.5%) (p 0.97). On average, GI performed the procedure faster than surgery [Median 10 (7-16) min vs 16 (13-21) mins, respectively, p < 0.001]. There were no significant differences between groups in any of the PEG outcomes or complications investigated.
Bedside PEG tube placement appears to be a safe procedure in the ICU population. GI and Surgery had nearly identical success rates in placing PEGs. GI performed the procedure faster than surgery. There were no significant differences in the reviewed patient outcomes or complications between PEGs placed by ACS or GI. Of note, when a complication occurred, ACS PEG patients typically were managed in the OR while GI tended to re-PEG patients highlighting a potential difference in management that should be further investigated.
经皮内镜胃造口术 (PEG) 管由全国各地的胃肠病学家 (GI) 和外科医生放置。在罗德岛医院，2017 年 7 月之前，所有 PEG 均由 GI 放置。2017 年 7 月，为了满足对 PEG 日益增长的需求，急性护理外科医生 (ACS) 也开始在 ICU 床边进行 PEG。本研究的目的是回顾和比较 ACS 和 GI 放置 PEG 管的结果。
回顾性分析 2016 年 12 月至 2019 年 9 月期间在任何 ICU 床边接受 ACS 或 GI 放置 PEG 的患者的病历。对以下结果进行评估：PEG 放置成功率、手术时间、主要并发症和死亡。次要结果包括出院处置以及 PEG 后仅接受舒适治疗的比例。
2017 年，75%的 PEG 由 GI 完成，25%由外科医生完成。2018 年，47%由 GI 完成，53%由外科医生完成。2019 年，33%由 GI 完成，67%由外科医生完成。外科医生 (156/173,93.6%) 和 GI (185/173,93.5%) 的成功率无显著差异 (p 0.97)。平均而言，GI 比外科医生更快地完成手术 [中位数 10 (7-16) 分钟与 16 (13-21) 分钟，分别，p < 0.001]。在研究的 PEG 结果或并发症方面，两组之间没有显著差异。
床边 PEG 管放置似乎是 ICU 人群中的一种安全手术。GI 和外科医生在放置 PEG 方面成功率几乎相同。GI 比外科医生更快地完成手术。ACS 或 GI 放置的 PEG 患者在接受评估的患者结局或并发症方面没有显著差异。值得注意的是，当发生并发症时，ACS PEG 患者通常在手术室接受治疗，而 GI 倾向于重新进行 PEG 治疗，这突显了管理上的潜在差异，应进一步调查。
