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We examined the success of a quality improvement initiative intended to prevent acute inpatient gastrostomy tube (g-tube) dislodgements. This was a retrospective cohort study of adult inpatients ≥18-years-old who underwent new g-tube placement at our institution (September 2021–August 2023). A new nursing order and revised nursing education, which specified standardized g-tube care, was implemented in September 2022. The incidence of g-tube dislodgments was compared between the pre-intervention and post-intervention cohorts. There were 555 ​g-tube placements, of which 236 occurred post-intervention. At one year after implementation, the compliance rate was 71.2 ​%. Patients with the new order had fewer dislodgements compared to those who did not have the order (8.3 ​% vs 29.4 ​%, P ​< ​0.001). Multivariable analysis demonstrated use of the order was associated with a decreased risk of dislodgement (OR 0.51, CI 0.28–0.99, P ​= ​0.046). Multidisciplinary initiatives can reduce the likelihood of complications and improve patient outcomes. [Display omitted] •Our institution implemented a new standardized gastrostomy tube nursing care order.•There was high compliance with the quality improvement intervention.•The incidence of acute gastrostomy tube dislodgements decreased after implementation.•Multidisciplinary initiatives can reduce complications and improve patient outcomes.

Background Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure; however, acute and chronic complications of PEG have been reported. We aimed to determine risk factors associated with complications and 30-day mortality after PEG, based on 11 years of experience at a single tertiary hospital. Methods In total, 401 patients who underwent first PEG insertion at the Asan Medical Center, Seoul, Korea, between January 2005 and December 2015 were eligible. Medical records were retrospectively reviewed to determine clinical characteristics and outcomes of 139 and 262 patients who underwent pull-type and introducer-type PEG, respectively. Results The median age of the overall population was 68 years, and the median body mass index was 19.5 kg/m 2 . Acute and chronic complications developed in 96 (23.9%) and 105 (26.2%) patients. Acute ileus and chronic tube obstruction were significantly more frequent in the introducer-type PEG group ( p  = 0.033 and 0.001, respectively). The 30-day mortality rate was 5.0% (median survival: 10.5 days). Multivariate analysis revealed that underlying malignancy was a predictor of acute complications; age ≥ 70 years and diabetes mellitus were predictors of chronic complications. The median follow-up was 354 days. Neurologic disease and malignancy were the most common indications for PEG. Neurologic diseases were classified into two groups: stroke and the other neurologic disease group (including dementia, Parkinson’s disease, neuromuscular disease, and hypoxic brain damage). Multivariate analysis showed that 30-day mortality was significantly lower in the other neurologic disease group and higher in patients with platelet count < 100,000/μL, and C-reactive protein (CRP) ≥ 5 mg/dL. Conclusions PEG is a relatively safe and feasible procedure, but it was associated with significantly higher early mortality rate in patients with platelet count < 100,000/μL or CPR≥5mg/dL, and lower early mortality rate in neurologic disease group including dementia, Parkinson's disase, neuromuscular disease, and hypoxic brain damage. In addition, acute complications in patients with underlying malignancy, and chronic complications in patients aged ≥70 and those with diabetes mellitus should be considered during and after PEG.

Objectives A novel partially self‐expandable metal stent (PCSEMS) with an anti‐migration system has recently become available during Endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) but requires tract dilation. No previous study has compared the performance of dilation devices during EUS‐HGS. The aim of this randomized controlled trial was to evaluate the technical success rate of tract dilation between a balloon catheter and drill dilator technique during EUS‐HGS prior to insertion of SEMS with an anti‐migration system. Methods A single‐center, randomized controlled trial comparing the balloon dilation and drill dilator techniques for first‐line tract dilation during EUS‐HGS. The primary outcome was the initial technical success rate of tract dilation for each technique during EUS‐HGS. The secondary outcome was adverse events associated with the procedures. Results Of 54 randomized patients who underwent EUS‐HGS at our center, there were 27 in the balloon dilation group and 27 in the drill dilation group. The initial technical success rate was 92.6% (25/27) in the balloon dilation group and 100% (27/27) in the drill dilation group (p = 0.1495). The technical success rate of stent delivery system insertion was significantly higher in the balloon dilation group (88%, 22/25) than in the drill dilation group (45%, 13/27; p = 0.0013). Procedure time was significantly shorter in the balloon dilation group (mean, 9.7 min) than in the drill dilation group (mean, 14.0 min; p = 0.047). Adverse events were more frequent in the drill dilation group (7.4% vs. 29.6%, p = 0.038). Conclusions Balloon dilation appears more suitable than drill dilation for PCSEMS with 8.5 Fr stent delivery system deployment. Clinical trial registration number University Hospital Medical Information Network 000049550.

Background Percutaneous endoscopic gastrostomy (PEG) is often used to provide nutritional support in locally advanced head and neck cancer patients undergoing multimodality treatment. However, there is little published data on the impact of prophylactic versus reactive PEG. PEG placement may affect swallowing-related physiology, function, and quality of life. The Swall PEG study is a randomized controlled phase III trial testing the impact of prophylactic versus reactive PEG on patient-reported outcomes in terms of swallowing and quality of life in oropharyngeal cancer patients. Methods Patients with locally advanced oropharyngeal cancer receiving chemo-radiotherapy will be randomized to either the prophylactic or reactive PEG tube group. Randomization will be stratified by human papillomavirus (HPV) status and unilateral versus bilateral positive neck lymph nodes. The primary objective of the study is the patient’s reported outcome in terms of swallowing (MD Anderson Dysphagia Inventory (MDADI)) at 6 months. Secondary objectives include health-related quality of life, dosimetric parameters associated with patient-reported outcomes, chemo-radiation toxicities, PEG tube placement complications, the impact of nutritional status on survival and toxicity outcomes, loco-regional control, overall survival, the impact of HPV and tobacco smoking on survival outcomes and toxicities, and the cost-effectiveness of each treatment strategy. Discussion Findings from this study will enhance clinical evidence regarding nutritional management in oropharyngeal cancer patients treated by concurrent chemo-radiation. Trial registration ClinicalTrials.gov NCT04019548, study protocol version 2.0_08/08/2019. Registered on 15 July 2019

PurposeA meta-analysis was performed to compare the rates of the major complications associated with two gastrostomy tube placement techniques in a pediatric population: laparoscopy-assisted gastrostomy (LAG) and percutaneous endoscopic gastrostomy (PEG).MethodsThe PubMed electronic database was queried for comparative studies of the two insertion techniques. The Newcastle–Ottawa scale (NOS) was used for the assessment of the quality and risk of bias in the included studies. The main outcome measure was the frequency of major complications defined as the need for reoperation within 30 days or death. RevMan 5.3, was used, with a p < 0.05 indicating statistical significance.ResultsEight studies including 1550 patients met the inclusion criteria. The risk for major complications was higher in PEG than in LAG 3.86 (95% confidence interval 1.90–7.81; p < 0.0002). The number needed to treat to reduce one major complication by performing LAG instead of PEG was 23. There were no randomized-controlled trials. Overall, the quality of the included studies was determined to be unsatisfactory.ConclusionsPEG placement was associated with a significantly higher risk of major complications compared to LAG placement. Therefore, LAG should be the preferred method for gastrostomy tube placement in children.

The AspireAssist System (AspireAssist) is an endoscopic weight loss device that is comprised of an endoscopically placed percutaneous gastrostomy tube and an external device to facilitate drainage of about 30% of the calories consumed in a meal, in conjunction with lifestyle (diet and exercise) counseling. In this 52-week clinical trial, 207 participants with a body-mass index (BMI) of 35.0-55.0 kg/m were randomly assigned in a 2:1 ratio to treatment with AspireAssist plus Lifestyle Counseling (n=137; mean BMI was 42.2±5.1 kg/m ) or Lifestyle Counseling alone (n=70; mean BMI was 40.9±3.9 kg/m ). The co-primary end points were mean percent excess weight loss and the proportion of participants who achieved at least a 25% excess weight loss. At 52 weeks, participants in the AspireAssist group, on a modified intent-to-treat basis, had lost a mean (±s.d.) of 31.5±26.7% of their excess body weight (12.1±9.6% total body weight), whereas those in the Lifestyle Counseling group had lost a mean of 9.8±15.5% of their excess body weight (3.5±6.0% total body weight) (P<0.001). A total of 58.6% of participants in the AspireAssist group and 15.3% of participants in the Lifestyle Counseling group lost at least 25% of their excess body weight (P<0.001). The most frequently reported adverse events were abdominal pain and discomfort in the perioperative period and peristomal granulation tissue and peristomal irritation in the postoperative period. Serious adverse events were reported in 3.6% of participants in the AspireAssist group. The AspireAssist System was associated with greater weight loss than Lifestyle Counseling alone.

Background Peristomal wound infection is a common complication in patients receiving percutaneous endoscopic gastrostomy (PEG). The main reason for peristomal infection might be the oral microbes coating the gastrostomy tube during implantation. Povidone-iodine solution can be applied for skin and oral decontamination. We designed a randomized controlled trial to test the effectiveness of a Betadine® (povidone-iodine) coated gastrostomy tube to reduce peristomal infection after percutaneous endoscopic gastrostomy. Methods A total of 50 patients were randomized to Betadine and control groups (25 patients in each group) from April 2014 to August 2021 at a tertiary medical center. All patients received the pull method for PEG implantation using a 24-french gastrostomy tube. The primary endpoint was peristomal wound infection rate 2 weeks after the procedure. Results Changes in Neutrophil/Lymphocyte ratio (N/L ratio) and C-Reative protein (Delta CRP) at 24 h after PEG were higher in the control group than in the Betadine group (N/L ratio, 3.1 vs. 1.2, p = 0.047; CRP, 2.68 vs.1.16, p = 0.009). The two groups did not differ in post-PEG fever, peristomal infection, pneumonia, or all-cause infection. Delta CRP could predict peristomal infection and all-cause infection within 2 weeks (AUROC 0.712 vs. 0.748; p  = 0.039 vs. 0.008). The best cut-off-point of Delta CRP for the diagnosis of peristomal wound infection was 3 mg/dl. Conclusion The betadine coating gastrostomy tube method could not reduce peristomal infection after percutaneous endoscopic gastrostomy. CRP elevation of less than 3 mg/dl may be used to exclude the potential peristomal wound infection. Trial registration NCT04249570 ( https://clinicaltrials.gov/ct2/show/NCT04249570 ).

Percutaneous endoscopic gastrostomy (PEG) has increasingly replaced surgical gastrostomy (SG) as the primary procedure for the long-term nutrition of patients with swallowing disorders. This prospective randomized study compares PEG with SG in terms of effectiveness and safety. This study enrolled 70 patients with swallowing disorders, mainly attributable to neurologic impairment. All the patients, eligible for both techniques, were randomized to PEG (pull method) or SG. The groups were comparable in terms of age, body mass index, and underlying diseases. Complications were reported 7 and 30 days after the operative procedure. The procedures were successfully completed for all the patients. The median operative time was 15 min for PEG and 35 min for SG (p < 0.001). The rate of complications was lower for PEG (42.9%) than for SG (74.3%; p < 0.01). The 30-day mortality rates were 5.7% for PEG and 14.3% for SG (nonsignificant difference). The findings show PEG to be an efficient method for gastrostomy tube placement with a lower complication rate than SG. In addition, PEG is faster to perform and requires fewer medical resources. The authors consider PEG to be the primary procedure for gastrostomy tube placement.

In our practice, there is a growing need to perform gastrostomy tube placement in infants and young children with feeding difficulties. To avoid possible complications arising from pull-through method (pull-through PEG) we began to perform a one-step endoscopic gastrostomy with a gastropexy device (push GT). This study aimed to evaluate the safety of this technique in infants and young children. In our study, 60 pull-through PEG and push GT procedures were retrospectively analysed in patients between 2.83 and 8.6 kg. We analysed the adverse events in both groups. Age, sex, weight, diagnosis, early (occurring ≤ 7 days after the procedure) and late (occurring > 7 days after the procedure) complications were compared in the two groups. Median follow-up duration was 12 months. Early minor complications occurred only in the push GT group, but this was not statistically significant. There was no significant difference between the groups regarding early major complications. Late minor complications were significantly more common in the push GT group. There were no late major complications in the push GT group, which is statistically significant. In infants and young children, push GT with a gastropexy device is a safe method to perform gastrostomy even in patients unsuitable for pull-through PEG placement.

One-step button percutaneous endoscopic gastrostomy (B-PEG) is a method for gastrostomy placement. Few studies have described complications associated with T-fasteners. This study aimed to assess the incidence and risk factors of post-gastrostomy T-bar retention. Children who underwent one-step button percutaneous endoscopic gastrostomy (B-PEG) placement in our tertiary center between 2009 and 2020 were included in this retrospective study. Patient characteristics, comorbidities, complications, and potential risk factors were analyzed. All post-procedure radiological examinations, T-bar numbers, and durations post-procedure were collected. T-bar retention was considered at least one T-bar after 6 weeks post-B-PEG. A total of 679 children (337 boys; median age at B-PEG, 1.7 years) were included. Among 483 patients with radiological examinations analyzed, 361 (74.7%) had at least one T-bar impaction at the first radiological examination (median time after B-PEG, 0.55 years). Younger age at B-PEG was a risk factor for T-bar impaction (odds ratio [OR]: 2.82, 95% confidence interval [CI]: [1.71–4.66], P  < .0001). Nearly 75% of children presented T-bar impaction. These data indicate that to avoid gastropexy complications, discussion of early removal of T-fasteners post-B-PEG is warranted.