Background: Even with a functioning gastrointestinal tract, it is
not always easy to initiate oral feeding in some neurosurgical patients
because of their persistently depressed neurologic status or severe lower
cranial nerve palsies. Percutaneous endoscopic gastrostomy (PEG) may be
required for long-term feeding in these patients. The purpose of the present
study is to report our experience with PEG chosen for establishing an enteral
route in patients of neurosurgical intensive care unit (ICU).
Methods: The outcome and complications of PEG in neurosurgical ICU
patients of Marmara University Institute of Neurological Science between
January 2001 and November 2006 were retrospectively evaluated.
Results: Thirty-one patients, with the median age of 51 years (range,
14–78 years) underwent PEG placement. PEG was placed before the
craniotomy in 2 patients and after in 29. Indications for PEG were absent gag
reflex in 10 patients and low Glasgow Coma Scale score in 21. Before the PEG
tube insertion, 18 patients had enteral nutrition by a nasogastric tube and 10
had parenteral nutrition (PN), with a median duration of 14.5 (range,
4–60) and 12 (range, 7–25) days, respectively. Two patients
accidentally pulled out the gastrostomy tubes 10 and 11 days after insertion.
Buried bumper syndrome developed in 1 patient. Two patients died 8 and 34 days
after the procedure in the neurosurgical ICU. Twenty-nine patients were
discharged from the hospital while being fed via the PEG tubes. In 11
patients who were able to resume oral feeding, the tube was removed, with a
median interval of 62 (range, 25–150) days. Procedure-related mortality,
30-day mortality, and overall mortality of the patients were 0%, 6.4%, and
45%, respectively. Conclusion: PEG is a safe and well-tolerated
gastrostomy method for neurosurgical ICU patients with depressed neurologic
state or severe lower cranial nerve palsies.
Percutaneous endoscopic gastrostomy (PEG) may be required for long-term feeding of patients having persistently depressed neurological status or severe lower cranial nerve palsies in the neurosurgical intensive care units. The purpose of the present study is to report our experience with PEG in these patients.
