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Philipps-Universität Marburg
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Abstract
This retrospective study evaluates the results of percutaneous radiological gastrostomy, executed on 60 patients between May 1996 and June 2004 at the Phillips-Universität Marburg. Previously, percutaneous endoscopic gastrostomy was considered impossible to be carried out with all of these patients.
All data were analyzed by using the following parameters: technical and functional success rate, complications, long-term use and mortality. Complications were divided into major, minor (those that needed only conservative treatment) and tube-related complications. The information was gathered by studying the patients’ documents, interviewing them, the family doctor or relatives personally or over the telephone.
The analyzed patients were divided into two groups: Group I contained 52 patients, 42 men and 10 women at the age of 3-90, who received radiological gastrostomy for the first time. The 8 patients of group II, 4 women and 4 men at the age of 8-78 received a change of an insufficient gastrostomy catheter.
Indications for gastrostomy were, on the one hand, enteral nutrition with obstructive and neurological dysphagia, and on the other hand gastrointestinal decompression because of obstruction and passage disorders of the stomach.
The technical success rate of group I was 88,5%. This result lies below those found in the literature of 95-100%. Reasons for this could be difficult anatomical circumstances such as interposition of viscera, dislocation of the stomach or impossible abdominal distension. A further reason for the aberrant technical success rate could be that radiological gastrostomy is not the method of first choice at the Phillips-Universtät Marburg. With most of the patients an endoscopic gastrostomy was carried out unsuccessfully or was considered impossible to be carried out.
Percutaneous radiological gastrostomy is an easy method to change dysfunctional tubes without difficulties, indicated by the technical success rate of 100% in group II and the easy changes of tubes that had become dysfunctional.
Catheter-related complications occurred in 62% of group I and in 37,5% of group II. Reasons for these complications were dislocations because of material damage, rip of the retention stitch or accidental loss of the catheter. Additionally, leakages and occlusions of probes occurred.
The placed catheters were usable after 48 hours in group I at 98%. One patient died before using the catheter. In group II all probes were usable after 48 hours, the functional success rate was 100%.
The results of this study show no difference from those known from the literature for the minor complications in both groups. Major complications occurred in 2% of patients of group I and 12,5% of group II after gastrostomy tube placement. The major complication rate known from the literature is between 0-6%.
The retention period in group I was 1-2465 days, with a medial length of stay of 233 ± 407 days, in group II 31-730 days, medial length of stay 348 ± 334 days.
Analysis of patients’ weight after catheter placement showed in both groups in most cases loss of weight, and only a few patients gained weight, maybe due to the underlying cancer diseases. Just a few patients gained weight.
The Karnofsky index declined in both groups during the study, which can be explained with the progressions of the underlying diseases.
Procedure related mortality occurred in 0% in both groups, concordant to the dates of the literature. The 30-days-mortality-rate occurred in 23% of group I, 0% of group II, and the 1-year-survival-rate resulted in 25% of group I, 62% of group II, median survival 15 months in group I, 44 months in group II. These values show the severity of diseases.
This study reveals that percutaneous radiological gastrostomy is an effective and safe method with a low complication rate, and is even after ineffective endoscopic gastrostomy successfully practicable. It is a method for long-term nutrition or for decompressing (?) the gastrointestinal tract during disorders of the passage of the stomach or small intestine. Furthermore, even necessary changes of insufficient probes are easily practicable without any invasive endoscopic intervention under fluoroscopic control.
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Dates
Created: 2007Issued: 2008-01-10Updated: 2011-08-10
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Gastrostomy
DFG-subjects
Gastrostomie
DDC-Numbers
610
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Haarmeyer, Anne (13377449X): Langzeitergebnisse der perkutanen radiologischen Gastrostomie. : Philipps-Universität Marburg 2008-01-10. DOI: https://doi.org/10.17192/z2007.0823.
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This item has been published with the following license: In Copyright