Impact of upper endoscopic survey during percutaneous endoscopic gastrostomy tube placement

• Published in: Surgical endoscopy Vol. 16; no. 1; pp. 112 - 114
• Main Authors: REGAN, J. P, DUNKIN, B. J, CHO, E. S, FLOWERS, J. L
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 2002; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Child; Endoscopes, Gastrointestinal; Endoscopy; Endoscopy, Gastrointestinal - methods; Esophagus; Female; Gastrostomy - instrumentation; Gastrostomy - methods; Humans; Male; Medical sciences; Medical treatment; Middle Aged; Ostomy; Pathology; Patients; Retrospective Studies; Small intestine; Stomach; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Ulcers; Gastrostomy; Human; Interest; Endoscopic surgery; Stomach; Digestive system; Laying process; Clinical investigation; Laparoscopy; Endoscopy; Diagnosis; Gastroscopy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-001-8101-2

No consensus exists concerning the utility of a full diagnostic upper endoscopy during percutaneous endoscopic gastrostomy (PEG) tube placement. We evaluate the effect of a complete survey on identifying and treating unsuspected gastrointestinal pathology. During a 10-year period (1990-2000), 1,706 patients underwent attempted PEG tube placement by five different surgical endoscopists at one institution. A complete survey of the esophagus, stomach, and proximal duodenum was attempted in all cases. Endoscopic findings and recommendations were recorded in a computerized log and patient charts. Pathology results were obtained from a computerized pathology database and patient charts. Placement of a PEG tube was successful in 97%, and a full survey was possible in 99% of the cases. Pathologic findings were found in 38% of the surveyed patients (esophagus, 7%; stomach, 24%; duodenum, 7%). One group with gastrointestinal polyps or gastric ulcers (5.7%) was identified as possible candidates for endoscopic intervention. In 30% of this group (1.8% of the total) a biopsy was performed, or bleeding was treated endoscopically. In a second group pathology was identified in the duodenum (6.4%) that would not have been recognized without a full survey. These duodenal findings resulted in a recommendation for treatment change in 38% of this group (2.4% of the total). Upper endoscopic survey before PEG tube placement showed a significant amount of unsuspected gastrointestinal pathology. Findings requiring biopsy, immediate treatment, or a change in medical treatment occurred in 4.2% of the cases, and these findings did not prevent PEG tube placement in any patient.