• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Percutaneous Endoscopic Gastrostomy With T-fasteners Obviates the Need for Emergent Exploration After Early Tube Dislodgement

Poochong Timratana, MD, Kevin M El-hayek, MD, Hideharu Shimizu, MD, Matthew Kroh, MD, Bipan Chand, MD FACS. Cleveland Clinic

 

INTRODUCTION: Despite technical refinements of percutaneous endoscopic gastrostomy (PEG), complications remain static. These complications include bleeding, tube site infection, and tube dislodgement. Tube dislodgement occurs more frequently in high risk patients such as those with altered mental status. The morbidity associated with early tube dislodgement is significant and often requires surgical exploration for gastrotomy repair and tube replacement. There is also risk of sepsis secondary to intraabdominal contamination. The purpose of this study is to review the experience from a high volume endoscopy center following the introduction of T-fastener placement in high risk patients. We hypothesize that procedure related morbidity will decrease when T-fasteners are used in patients with early tube dislodgement.

METHODS: We retrospectively reviewed PEG placement over the preceding 12 months (October 2010—September 2011) when our group began to selectively use T-fasteners in high risk patients. Patients with altered mental status deemed to have an increased risk for early tube dislodgement underwent T-fastener placement at the time of PEG placement. Charts were retrospectively reviewed and patients with PEG alone were compared with those patients who had PEG with T-fastener (PEG-T). Statistical analysis was performed using SPSS version 18.

RESULTS: A total of 195 patients underwent PEG placement during the study period. PEG alone was performed on 121 patients, while PEG-T was performed on 74 patients. Mean age for PEG alone versus PEG-T was 64.2 +/- 15.1 and 71.0 +/-15.2 years respectively (p=0.001). Indication was feeding access in 102/119 (86%) patients who had PEG alone and 68/74 (92%) who underwent PEG-T (p=0.12). The other patients had PEG placement for decompression. Neurologic deficit (i.e. cerebrovascular accident, dementia) was identified in 64/121 (53%) with PEG and 58/74 (78%) with PEG-T (p<0.01). In an attempt to further identify an increased risk for early tube dislodgement, a clinical assessment involving communication with nursing teams as well as review of the electronic medical record was performed. There were 7 complications overall. In the PEG cohort, 1 patient had intraluminal bleeding requiring repeat endoscopy. Six patients had early tube dislodgement in the PEG-T cohort versus none in the PEG cohort (p=0.003). Mean time to tube dislodgement following PEG placement was 5.0 +/- 6.3 days. The first patient underwent diagnostic laparoscopy with replacement gastrostomy 2 days following tube dislodgement and was noted to have no contamination and an intact gastropexy. The subsequent 5 patients underwent non-emergent PEG replacement in the endoscopy unit within 48 hours of tube dislodgement. In short term follow-up, no repeat dislodgements were noted. Overall mortality at last follow up was 38/195 (19.5%) and was related to underlying disease.

CONCLUSION: Neurologically impaired patients constitute a high percentage of adults undergoing PEG placement. Subtle clues such as need for restraints prior to PEG may alert the clinician of a higher risk for early tube dislodgement. Placement of T-fasteners in this group may decrease overall morbidity if early tube dislodgement occurs. We have shown safety in non-emergent replacement of PEG in such patients. Need for PEG in adults remains a marker for mortality.


Session Number: Poster – Poster Presentations
Program Number: P632
View Poster

6,953

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2012 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons