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Perkutane endoskopische Gastrostomie

Komplikationen mit und ohne Antikoagulation

Percutaneous endoscopic gastrostomy

Complications with and without anticoagulation

  • Klinische Studien
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Zusammenfassung

Hintergrund

Die perkutane endoskopische Gastrostomie (PEG) wird bislang als Hochrisikoeingriff klassifiziert (ASGE-Leitlinien). Koagulopathien, Thrombozytenaggregationshemmer (Aspirin, Clopidogrel u.a.) und Phenprocoumon bzw. Wafarine gelten als Kontraindikationen. Die Studie untersucht erstmals Komplikationen und Risikofaktoren bei Patienten mit und ohne Antikoagulation.

Material und Methoden

An der Klinik für Allgemein- und Viszeralchirurgie der Universität Freiburg wurden zwischen 2001 and 2007 insgesamt 450 Patienten mit neurologischer Dysphagie mit einer PEG versorgt und prospektiv während des stationären Aufenthalts untersucht. Die Patienten wurden drei Gruppen zugewiesen: Gruppe 1: keine Antikoagulation (n=50), Gruppe 2: Prophylaxe mit niedermolekularem Heparin (NMH, n=152), Gruppe 3: therapeutische Antikoagulation und Thrombozytenaggregationshemmer (UFH, NMH, Phenprocoumon, Acetysalicylsäure, Clopidogrel und Kombinationen, n=248). 11 Risikofaktoren und die Komplikationen Infektion, Blutung und Peritonitis wurden univariat analysiert (p-Wert, Odds Ratio [OR], 95%-Konfidenzintervall [KI]).

Ergebnisse

Der mittlere stationäre Aufenthalt betrug 27,4 Tage (1–268). Die Krankenhausmortalität betrug 6%. Ein PEG-abhängiger Todesfall trat nicht auf. Es zeigten sich 6,6% peristomale Infekte (n=30) und 1,3% Peritonitiden (n=6). Eine Post-PEG-Blutung wurde weder mit noch ohne Antikoagulation beobachtet. Die untersuchten Risikofaktoren zeigten sich in der Vorhersage auf o.g. Komplikationen statistisch nicht signifikant und konnten aufgrund der geringen Anzahl nicht multivariat getestet werden.

Schlussfolgerung

Komplikationen der PEG mit der Fadendurchzugsmethode sind per se selten. Ein erhöhtes PEG-assoziiertes Blutungsrisiko unter therapeutischer Antikoagulation wurde nicht beobachtet. Unseres Erachtens kann nach den vorliegenden Daten bei ausgewählten Patienten mit hohen Thromboembolierisiken eine PEG-Anlage auch ohne Absetzen der Antikoagulation erfolgen.

Abstract

Background

Percutaneous endoscopic gastrostomy (PEG) has been classified to date as a high-risk procedure (ASGE guidelines). Coagulopathies, thrombocyte aggregation inhibitors (Aspirin, clopidogrel etc.) and phenprocoumone or warfarin are considered to be contraindications. The study examined for the first time the risk factors in patients with and without concurrent anticoagulation.

Methods

Between 2001 and 2007 PEGs were placed in 450 patients with neurological diseases at the University Hospital for General and Visceral Surgery in Freiburg and studied prospectively during hospitalization. The patients were divided into 3 groups: group 1 controls (n=50, no anticoagulation), group 2 low-molecular-weight heparin (LMWH) prophylaxis (n=152) and group 3 therapeutic anticoagulation (unfractionated heparin, phenprocoumone, therapeutic LMWH, aspirin, clopidorel and combinations, n=248). Univariate analyses were performed to determine risk factors for the occurrence of infection, bleeding and peritonitis. The p-values (p), odds ratios (OR) and 95% confidence intervals (CI) are given.

Results

The average hospitalization time was 27.4 days (range 1–268 days) and hospital mortality was 6%. There were no cases of death due to the PEG. Complications included peristomal infections (n=30, 6.6%) and peritonitis (n=6, 1.3%). Post-PEG bleeding did not occur either with or without anticoagulation. The investigated risk factors showed no statistically significant values with respect to prognosis for these complications. Multivariate testing could not be carried out due to the low number of complications.

Conclusion

Complications of PEG placement with the method used here are rare. An increased risk of bleeding during therapeutic anticoagulation was not observed. In our opinion the present data indicate that PEG placement can be carried out in selected patients with increased risk of thromboembolism without discontinuation of anticoagulation.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie mit Poliklinik, Albert-Ludwigs-Universität, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Deutschland

    O. Ruthmann , A. Seitz, S. Richter , G. Marjanovic , U.T. Hopt , A. Fischer  &  H.-J. Schrag

  2. Abteilung für Medizinische Biometrie und Statistik, Institut Med. Biometrie und Informatik , Albert-Ludwigs-Universität, Freiburg im Breisgau, Deutschland

    M. Olschewski

Authors
  1. O. Ruthmann
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  2. A. Seitz
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  3. S. Richter
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  4. G. Marjanovic
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  5. M. Olschewski
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  6. U.T. Hopt
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  7. A. Fischer
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  8. H.-J. Schrag
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Correspondence to H.-J. Schrag.

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Ruthmann , O., Seitz, A., Richter , S. et al. Perkutane endoskopische Gastrostomie. Chirurg 81, 247–254 (2010). https://doi.org/10.1007/s00104-009-1718-8

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  • DOI: https://doi.org/10.1007/s00104-009-1718-8

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