Local infection after percutaneous endoscopic gastrostomy in ENT tumor patients: evaluation of the influence of the abdominal thickness and other parameters
Konstantinos Mantsopoulos, Johannes Zenk, Peter C. Konturek, Heinrich Iro
Med Sci Monit 2010; 16(3): CR116-123
The percutaneous endoscopic gastrostomy is the method of choice in patients with advanced tumours of the upper aerodigestive tract, after surgery or before radiochemotherapy, for the establishment of a sufficient nutrition therapy. The aim of this observation study was to investigate, to what extent the abdominal thickness and other factors have an influence on the rate of peristomal infection after a percutaneous endoscopic gastrostomy.
Material and Method: Percutaneous endoscopic gastrostomy was performed on 135 patients in 2008-2009. 101 patients were fully evaluated and included in the study. The different layers of the abdominal wall were measured with B-scan ultrasound (7.5 MHz). Furthermore, potential patient-related risk factors (gender, age, nutritional status (Body Mass Index, Nutritional Risk Score, total serum protein, the tumor stage and presence of Diabetes mellitus) and their effect on the occurrence of a wound infection were evaluated.
Results: A peristomal infection was documented in 21.8% of the patients (22/101). Serious complications were not observed. There were no statistically significant predictors for the occurrence of a peristomal infection detected.
Conclusions: The hypothesis that the abdominal wall thickness has an influence on the rate of the peristomal infection is not confirmed. This is of clinical relevance in patients, who are still in a relatively good general and nutritional condition before radiochemotherapy. The intraoperative ultrasonography can be used to guide catheter insertion while providing a safe adjunct to confirm proper tube placement and minimizing the risk of inadvertently entering adjacent intraabdominal organs.
Keywords: Insufflation, Head and Neck Neoplasms - therapy, Gastrostomy - adverse effects, Gastroscopy - adverse effects, Body Mass Index, Abdomen - ultrasonography, Muscles - pathology, Surgical Wound Infection - etiology