Gastroenterologist versus Surgeon Performed Endoscopic Gastrostomy: A Multi-Centre Comparative Study.

摘要

PEG tube placement has been widely embraced by endoscopists as a means of accessing the gastrointestinal tract for feeding. In this study we compared the outcomes of PEG tube placement by gastroenterologists and surgeon endoscopists.Materials and MethodsData on PEG outcomes were retrospectively collected over 31 months from the Georgetown Hospital in the Cayman Islands where PEGs were performed exclusively by surgeons. This was compared with data collected over the same period from the University Hospital of the West Indies in Jamaica where PEGs were performed exclusively by gastroenterologists.ResultsThere were 74 PEG tubes placed by gastroenterologists and 35 placed by surgeons. The gastroenterologists had a higher collective case volume than surgeons (37 vs 18 cases per year). There were no significant differences between gastroenterologist and surgeon performed PEG in terms of procedural success (98.6% vs 100%; P=0.84), overall morbidity (6.8% vs 8.8%; P=0.71), early mortality (4.3% vs 0; P=0.549) or late mortality (11.8% Vs 0; P=0.049).ConclusionsAppropriately trained surgeon endoscopists and gastroenterologists can site PEG tubes with similar success and complication rates. Introduction PEG tube placement has been widely embraced by endoscopists as a means to access the gastrointestinal (GI) tract for feeding. The technique is becoming increasingly popular in many Caribbean territories (1-3). At the University Hospital of the West Indies (UHWI) in Jamaica, gastroenterologists have been performing PEG tube placement since 1999 (1). Surgeons have not become involved in this practice largely because endoscopic training is not incorporated into surgical post-graduate programmes at the UHWI. In contrast, most North American and European training centres incorporate endoscopic procedures into their surgical residency programmes (4). In these settings, surgeons perform several diagnostic and therapeutic upper and lower GI endoscopies, including PEG.We carried out this comparative study of PEG tube placement between the two disciplines to determine the safety of this practice by surgeon endoscopists. Since this practice has not yet become realized at the UHWI, data from the Cayman Islands were used as controls for surgeon-performed PEG. Materials And Methods Data on PEG tube placement were retrospectively collected over a period of 31 months from January 2005 to August 2007. The hospital records of all patients who had PEG placement during the study periods were retrieved for analysis. Records were collected from the UWHI in Jamaica where PEG placement were performed exclusively by gastroenterologists and from the Georgetown Hospital in the Cayman Islands where PEG tubes were placed exclusively by surgeons. Patients who were transferred from other hospitals for this service were excluded from the final analysis as their records would not be available for review.The standard “pull technique” was utilized at both centers with one of several commercially available PEG introduction systems: Freka? PEG Set (Fresenius Ltd, Warrington, UK); Ponsky? PEG Kit (Bard Endoscopic Technologies, Massachusetts, USA); Cook? PEG Kit (Wilson-Cook Medical Inc, North Carolina, USA). Prophylactic antibiotics were routinely used at both hospitals. The operative techniques have already been detailed in previous reports (1, 3). The data collected included case volume, success rates, PEG-specific morbidity, and early mortality. These data were entered in a Microsoft Excel? worksheet and analyzed using SPSS version 12.0. The outcomes were assessed by Pearson’s Chi-square and Fisher’s exact tests. Significance was considered present with a two-tailed P value < 0.05. Results There were 35 surgeon-led procedures identified during the study period. There were 15 males and 20 females, with ages ranging from 49 to 92 years (Mean +/-SD: 77+/-14.4). Hospital records were retrieved for all the patients for detailed analysis. The operations were performed by one of