ROUTINE POST-PROCEDURAL CLINIC VISIT AFTER ELECTIVE, OUTPATIENT PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE PLACEMENT IS NOT NECESSARY
Antoinette Hu*1, Ellius J. Kwok2, Alexander T. Liu1, Colin G. Delong1, Michael F. Reed1, Eric M. Pauli1
1General Surgery, Penn State Health Milton S Hershey Medical Center, Hershey, PA; 2Penn State College of Medicine, Hershey, PA
ROUTINE POST-PROCEDURAL CLINIC VISIT AFTER ELECTIVE, OUTPATIENT PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE PLACEMENT IS NOT NECESSARY.
Background: Percutaneous endoscopic gastrostomy (PEG) tube placement is the most common method of obtaining durable enteral feeding access and is commonly performed by medical and surgical endoscopists. Currently, there is no consensus on the timing or necessity of routine post-procedure clinic visits after elective outpatient PEG tube placement. This study sought to determine whether routine post-operative visits were necessary by evaluating the frequency and type of acute complications following outpatient PEG placement.
Methods: An institution review board approved, retrospective chart review was conducted for all adults over 18 years old who underwent elective, outpatient PEG tube placement by two surgeons at a single, tertiary academic medical center from January 2010 to June 2021. Demographics, medical comorbidities, and post-procedural complications within 60 days of procedure were assessed.
Results: 110 patients meeting inclusion criteria were identified (mean age of 61.3 years, mean body mass index of 24.3 kg/m2, and 41.3% female). All patients underwent elective outpatient PEG placement via Ponsky-pull method. Seven (6.4%) acute complications occurred, including 3 superficial skin infections, 2 pneumoperitoneum, 1 skin erosion at the tube site, and 1 tube dislodgement. Complications occurred on average 7.8 days post-procedure (range of 1 to 18 days). Three of these complications (pneumoperitoneum and tube dislodgement) were identified on presentation to the emergency department. One patient with pneumoperitoneum required operative intervention for gastropexy. The remainder were detected during an unscheduled clinic visit following a patient call into the office.
Discussion: Our results suggest that the overwhelming majority of patients (93.6%) do not require a routine "PEG check" clinic visit following outpatient gastrostomy placement. Complications following outpatient PEG placement are most commonly detected by patients themselves within the first week of placement, prompting them to seek more urgent medical care. Therefore, it is likely safe, cost-effective, and convenient for patients to only schedule post-procedural clinic visits on an as-needed basis after outpatient PEG tube placement.
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