IDDF2021-ABS-0110 The feasibility of percutaneous endoscopic gastrostomy (peg) in post-gastrectomy patients

Background Although percutaneous endoscopic gastrostomy (PEG) is considered the route of choice for long-term enteral nutrition, this procedure may be difficult to perform in post-gastrectomy patients and research addressing this issue is limited. We report our experience with PEG, percutaneous endoscopic duodenostomy (PED) and percutaneous endoscopic jejunostomy (PEJ) performed in post-gastrectomy patients at our hospital. Methods 29 post-gastrectomy patients (23 men and 6 women) who received PEG for enteral nutrition at our hospital between April 2007 and April 2021 were included in this study. Baseline characteristics and clinical outcomes of interest were analyzed retrospectively. Results Mean age was 81.7 (range: 61 to 93) years old. 18 patients (62%) had cerebrovascular disease, 14 patients (48%) had dementia and 12 patients (41%) had respiratory diseases as comorbidities contributing to their dysphagia. 22 patients underwent distal gastrectomy (14 Billroth I procedures and 8 Billroth II procedures), 2 patients received proximal gastrectomy and 5 had either wedge or central gastrectomy. 26 patients received their catheter placements using the Push technique, while 3 had the Introducer technique used. In 8 patients with distal gastrectomy, the catheter was inserted slightly beyond the anastomosis site (PED/PEJ). Postoperatively, 8 patients (28%) developed peristomal infection/leakage, including 3 of the PED/PEJ patients (37%). Feeding-related aspiration pneumonia was observed in 5 patients (17%) and diarrhea in 3 patients (10%). The average postoperative length of stay was 25.6 days. 3 patients (10%) died before discharge but none within 30 days after the procedure. Conclusions We reported our experience with PEG/PED/PEJ in 29 post-gastrectomy patients. When successfully performed in these patients, PEG can remain a useful procedure for enteral nutrition, with mortality rates comparable to other PEG patients. However, post-gastrectomy patients (especially for PED/PEJ) may be more prone to peristomal complications.