Percutaneous endoscopic gastrostomy (PEG) has become the method of choice for mid-to long-term enteral feeding. The majority of complications that occur are minor, but the rare major complications may be life threatening. Some complications occur soon after tube placement, others develop later, when the gastrostomy tract has matured. Older patients with comorbidities and infections appear to be at a greater risk of developing complications. Apart from being aware of indications and contraindications, proper technique of PEG placement, including correct positioning of the external fixation device, and daily tube care are important preventive measures. Adequate management of anticoagulation and antithrombotic agents is important to prevent bleeding, and administration of broad spectrum antibiotics prior to the procedure helps prevent infectious complications. Early recognition of complications enables prompt diagnosis and effective therapy.

• Klíčová slova
• Bleeding, Complication, Fistula, Percutaneous endoscopic gastrostomy, Wound infection,
• MeSH
• enterální výživa MeSH
• gastrointestinální intubace škodlivé účinky   metody   MeSH
• gastroskopie škodlivé účinky   MeSH
• gastrostomie škodlivé účinky   metody   MeSH
• lidé MeSH
• pooperační komplikace etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Since 1980, when percutaneous endoscopic gastrostomy was described and performed for the first time, the number of patients with this way of nutrition has been growing. At present, however, these patients are treated not only in intensive care units, but also in follow-up care institutions or in home care. AIM: We want to explain the problems of nutrition via endoscopic gastrostomy to those physicians who take long-term care of these patients. METHODS: In our department we introduced percutaneous endoscopic gastrostomy in 1994. A total of 78 PEGs were performed. In all cases the pull technique was used. A condition for percutaneous endoscopic gastrostomy insertion was an unaffected gastrointestinal tract from the stomach in aboral direction. The most frequent indications were: necessity of long-term enteral nutrition in patients during artificial ventilation, neurological patients with lost swallowing reflex, and patients with a tumor in the ENT area with preserved patency for the endoscope. RESULTS: In all cases, the intervention itself was without major complications and no death occurred relating to the intervention. Subsequently, mainly local complications such as decubitus ulcers or maceration around the tube and its accidental removal by a restless patient were noticed. CONCLUSION: In cases of more than 6-week inability to ingest food per os with otherwise unaffected gastrointestinal tract, it is appropriate to consider the nutrition via PEG. Using this method, it is possible to ensure an adequate access for enteral nutrition for a longer time without risk of complications associated with the nasoenteric tube, with minimum trouble to the patient. (Fig. 1, Ref. 9.).

• MeSH
• enterální výživa * škodlivé účinky   metody   MeSH
• gastrostomie * škodlivé účinky   metody   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Percutaneous endoscopic gastrostomy (PEG) is a widely used method of nutrition delivery for patients with long-term insufficiency of oral intake. The PEG complication rate varies from 0.4% to 22.5% of cases, with minor complications being three times more frequent. Buried bumper syndrome (BBS) is a severe complication of this method, in which the internal fixation device migrates alongside the tract of the stoma outside the stomach. Excessive compression of tissue between the external and internal fixation device of the gastrostomy tube is considered the main etiological factor leading to BBS. Incidence of BBS is estimated at around 1% (0.3%-2.4%). Inability to insert, loss of patency and leakage around the PEG tube are considered to be a typical symptomatic triad. Gastroscopy is indicated in all cases in which BBS is suspected. The depth of disc migration in relation to the lamina muscularis propria of the stomach is critical for further therapy and can be estimated by endoscopic or transabdominal ultrasound. BBS can be complicated by gastrointestinal bleeding, perforation, peritonitis, intra-abdominal and abdominal wall abscesses, or phlegmon, and these complications can lead to fatal outcomes. The most important preventive measure is adequate positioning of the external bolster. A conservative approach should be applied only in patients with high operative risk and dismal prognosis. Choice of the method of release is based on the type of the PEG set and depth of disc migration. A disc retained inside the stomach and completely covered by the overgrowing tissue can be released using some type of endoscopic dissection technique (needle knife, argon plasma coagulation, or papillotome through the cannula). Proper patient selection and dissection of the overgrowing tissue are the major determinants for successful endoscopic therapy. A disc localized out of the stomach (lamina muscularis propria) should be treated by a surgeon.

• Klíčová slova
• Buried bumper syndrome, Complication, Endoscopy, Enteral nutrition, Percutaneous endoscopic gastrostomy,
• MeSH
• design vybavení MeSH
• enterální výživa škodlivé účinky   přístrojové vybavení   metody   MeSH
• gastroskopie škodlivé účinky   přístrojové vybavení   MeSH
• gastrostomie škodlivé účinky   přístrojové vybavení   metody   MeSH
• lidé MeSH
• migrace cizích těles diagnostické zobrazování   etiologie   terapie   MeSH
• odstranění implantátu MeSH
• rizikové faktory MeSH
• selhání zařízení MeSH
• výsledek terapie MeSH
• zaváděcí katétry škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

A two-year-old girl with two weeks of abdominal pain, vomiting, and food refusal, ten months after percutaneous endoscopic gastrostomy insertion because of inadequate peroral intake, was admitted to a tertiary centre hospital. On admission, the extracorporeal part of the gastrostomy was much shortened. X-ray examination revealed migration of the end of the gastrostomy tube with a left-shifted course of the tube through the duodenum. Gastroscopy and subsequently laparotomy were performed. A longitudinal pressure necrosis was identified under the tube, with two perforations in the duodenojejunal region. Ten centimeters of that duodenojejunal region were resected, and end-to-end anastomosis was made. The migration of the gastrostomy was probably caused by insufficient care by the parents. Pathophysiologically, the tube caused the pressure necrosis in the duodenojejunal area; this was supported by histology. This is a hitherto undescribed complication of a percutaneous endoscopic gastrostomy, showing that migration of the gastrostomy to the deeper part of the small bowel can lead to pressure necrosis, a potentially life-threatening condition in children which cannot be treated without invasive procedures.

• Klíčová slova
• children, migration, percutaneous endoscopic gastrostomy, perforation, pressure necrosis,
• MeSH
• duodenum patologie   MeSH
• enterální výživa MeSH
• gastroskopie MeSH
• gastrostomie škodlivé účinky   MeSH
• lidé MeSH
• nekróza etiologie   MeSH
• nemoci duodena etiologie   chirurgie   MeSH
• odstranění implantátu MeSH
• perforace střeva etiologie   chirurgie   MeSH
• předškolní dítě MeSH
• selhání protézy škodlivé účinky   MeSH
• tlak škodlivé účinky   MeSH
• zaváděcí katétry škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

AIM: The authors evaluate their experience with percutaneous endoscopic gastrostomy in children at the age of three months to 14 years. COHORT: Forty three patients treated with this method in the years 1995-2002. METHODS: The percutaneous endoscopic gastrostomy is applied in children under general anesthesia. In two patients only it proved to be necessary to convert to open or laparoscopic gastrostomy. RESULTS: Only minor complications were encountered. CONCLUSIONS: It became obvious that percutaneous endoscopic gastrostomy is a suitable method to provide long-term enteral nutrition in children of child age who may not be nourished sufficiently by natural ways.

• MeSH
• dítě MeSH
• enterální výživa * MeSH
• gastrointestinální endoskopie * MeSH
• gastrostomie škodlivé účinky   metody   MeSH
• kojenec MeSH
• kontraindikace MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The authors present their initial experience with percutaneous endoscopic gastrostomy and draw attention to its advantages and risks. As a basis they use their own group of patients, most of them in a very poor condition where it proved possible to ensure by this method enteral nutrition on a long-term basis.

• MeSH
• endoskopie metody   MeSH
• endoskopy MeSH
• gastrostomie přístrojové vybavení   metody   MeSH
• lidé MeSH
• punkce MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

PURPOSE: Surgical Gastrostomy has been around since the 19th century but in 1980 the first successful percutaneous endoscopic gastrostomy was reported. A year later the first successful percutaneous gastrostomy was performed using fluoroscopic guidance. The technique for percutaneous insertion and the equipment used has been refined since then and it is now considered the gold standard for gastrostomy insertion. Here we present guidelines for image-guided enteral feeding tubes in adults. MATERIAL AND METHOD: We performed a review and analysis of the scientific literature, other national and international guidelines and expert opinion. RESULTS: Studies have shown fluoroscopic techniques have consistently higher success rates with lower rates of major complications than endoscopic techniques. However, the Achilles' heel of many fluoroscopic techniques is the requirement for smaller gastrostomy tube sizes resulting in them being more prone to blockages and thus requiring further intervention. CONCLUSION: Radiological feeding tube insertion is a safe and effective procedure. Success rates are higher, and complication rates lower than PEG or surgical gastrostomy tube placement and innovative techniques for gastric and jejunal access mean that there are very few cases in which RIG is not possible. The principal weakness of radiologically inserted gastrostomies is the limitiation on tube size which leads to a higher rate of tube blockage. Per-oral image-guided gastrostomies have to an extent addressed this but have not been popularised. Currently many centres still consider endoscopic gastrostomies as the first line unless patients are too unwell to undergo this procedure or previous attempts have failed, in which case radioloically inserted gastrostomies are the technique of choice.

• Klíčová slova
• Disease, Enteral feeding, Gastrointestinal, Gastrojejunostomy/percutaneous endoscopic gastrostomy (PEG), Non-vascular interventions, Organ, Per-oral image-guided gastrostomy (PIG), Radiologically inserted gastrostomy (RIG), Specialty, Stroke, Sub-specialty/technique, Subspecialty/technique,
• MeSH
• dospělí MeSH
• gastrostomie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH

The authors have described the indications, contraindications of percutaneous endoscopic gastrostomy (PEG) and its consecutive nutritional possibilities. They have described their own experience with 11 patients. Most common indications for the placement of a gastrostomy tube were neurological, and only in one case, esophageal diverticle. The average duration of PEG was 102 days (2-732). Besides PEG, not only polymeric diet, such as Nutrison standard sol, Fresubin, Salvimulsin, was administered, but also home-made diet, for example, mixed soup, mashed potatoes, yoghurt, juice and cocoa. The diet prepared at home was tolerated well, except for subjective data about meteorism given by one female-patient. PEG complications were minimal, in one case a dry fistula was detected after the extraction of PEG; it was closed spontaneously a week later. Another female-patient showed leukocytosis and hyperpyrexia, the etiology of which could not be proved. The patient was treated symptomatically, and three days later, leukocytosis and hyperpyrexia were normalized. A patient who has had the gastrostomy tube placed for two years, showed secretion which was treated symptomatically; now the patient is without any complications. In the last patient, there was detected an inflammation around the fixation base. Although she was treated with H2 blockers, the condition has not been improved. The authors have recommended this method in correct indications as a considerate alternative application of enteral nutrition.

• MeSH
• dospělí MeSH
• endoskopie MeSH
• enterální výživa * MeSH
• gastrostomie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• punkce MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

BACKGROUND: The aim of this study was to monitor oropharyngeal bacterial colonization in patients indicated for percutaneous endoscopic gastronomy (PEG). METHODS: Oropharyngeal swabs were obtained from patients prior to PEG placement. A development of peristomal infection was evaluated. The analysis of oropharyngeal and peristomal site pathogens was done. RESULTS: Consecutive 274 patients referred for PEG due to neurological disorder or cancer completed the study. Oropharyngeal colonization with pathogens was observed in 69% (190/274), dominantly in the neurologic subgroup of patients (P < 0.001). Peristomal infection occurred in 30 (10.9%) of patients and in 57% of them the correlation between oropharyngeal and peristomal agents was present. The presence of oropharyngeal pathogens was assessed as an important risk factor for the development of peristomal infection only in oncological patients (OR = 8.33, 95% CI: 1.66-41.76). Despite a high prevalence of pathogens in neurological patients, it did not influence the risk of peristomal infection with the exception for methicillin resistant Staphylococcus aureus (MRSA) carriers (OR 4.5, 95% CI: 1.08-18.76). CONCLUSION: During oropharyngeal microbial screening prior to the PEG insertion, the detection of pathogens may be a marker of the increased risk of peristomal infection in cancer patients only. In neurological patients the benefit of the screening is limited to the detection of MRSA carriers.

• MeSH
• bakteriální infekce mikrobiologie   MeSH
• endoskopie škodlivé účinky   metody   mortalita   MeSH
• gastrostomie škodlivé účinky   metody   mortalita   MeSH
• infekce chirurgické rány epidemiologie   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory hlavy a krku epidemiologie   chirurgie   MeSH
• nemoci nervového systému epidemiologie   chirurgie   MeSH
• orofarynx mikrobiologie   MeSH
• přenašečství mikrobiologie   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

"Buried bumper syndrome" is a less frequent but potentially serious complication of percutaneous endoscopic gastrostomy. We present case reports of two patients in whom buried bumper syndrome was diagnosed by means of X-ray examination and endoscopic examination. In both cases the original gastrostomy was surgically removed and classical gastrostomy was performed.

• MeSH
• gastroskopie * MeSH
• gastrostomie škodlivé účinky   přístrojové vybavení   MeSH
• lidé středního věku MeSH
• lidé MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH