New "introducer" PEG-gastropexy with T fasteners: a pilot study

Abstract

CONTEXT: Enteral feeding is indicated for patients unable to maintain appropriate oral intake, and percutaneous endoscopic gastrostomy (PEG) is the most adequate long-term enteral access. Peristomal infections are the most common complications of PEG, occurring in up to 8% of patients, despite the use of prophylactic antibiotics. The "introducer" PEG-gastropexy technique avoids PEG tube passage through the oral cavity, preventing microorganisms' dislodgment to the peristomal site. OBJECTIVES: To compare the incidence of peristomal wound infection at 7-day post-procedure after conventional "pull" technique versus a new "introducer" PEG-gastropexy kit. Secondary outcomes included success rates, procedure time, and other complications. METHODS: Eighteen patients referred for PEG placement between June and December 2010 were randomly assigned to "pull" PEG with antibiotics or "introducer" PEG-gastropexy technique without antibiotics. RESULTS: Overall success rate for both methods was 100%, although mean procedure duration was higher in the "introducer" PEG-gastropexy group (12.6 versus 6.4 minutes, P = 0.0166). Infection scores were slightly higher in patients who underwent "pull" PEG with antibiotics compared with "introducer" PEG-gastropexy without antibiotics (1.33 ± 0.83 versus 0.75 ± 0.67, P = 0.29). CONCLUSION: Although procedure duration was longer in the "introducer" PEG-gastropexy, infection scores were marginally higher in the "pull" PEG technique.