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Canadian Journal of Gastroenterology
Volume 22, Issue 12, Pages 987-991
Original Article

Local Infection after Placement of Percutaneous Endoscopic Gastrostomy Tubes: A Prospective Study Evaluating Risk Factors

Y Zopf,1 P Konturek,1 A Nuernberger,1 J Maiss,1 J Zenk,2 H Iro,2 EG Hahn,1 and D Schwab3

1Department of Medicine, Friedrich–Alexander-University, Erlangen, Waldstrasse 1, Germany
2Department of Otolaryngology, Head and Neck Surgery, Friedrich–Alexander–University, Erlangen, Waldstrasse 1, Germany
3Department of Medicine II, Martha–Maria Hospital, Stadenstraße, Nuremberg, Germany

Received 25 July 2008; Accepted 5 October 2008

Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Due to its high efficacy and technical simplicity, percutaneous endoscopic gastrostomy (PEG) has gained wide-spread use. Local infection, occurring in approximately 2% to 39% of procedures, is the most common complication in the short term. Risk factors for local infection are largely unknown and therefore – apart from calculated antibiotic prophylaxis – preventive strategies have yet to be determined.

OBJECTIVE: To assess the potential patient- and procedure-related risk factors for peristomal infection following PEG tube placement.

METHODS: Potential patient-related (eg, age, sex, diseases, body mass index, concomitant antibiotic therapy) and procedure-related (endoscopist experience, institutional factors, findings on endoscopy) risk factors and their coincidence with local infection, defined as a positive peristomal infection three days after PEG tube placement, were evaluated at two institutions. A standardized antibiotic prophylaxis was not performed. The peristomal infection score was also evaluated in 390 patients.

RESULTS: Using a multivariate binary regression analysis, four risk factors were established as relevant for local infection after PEG: clinical institution (OR 6.69; P=0.0001), size of PEG tubes (15 Fr versus 9 Fr; OR 2.12; P=0.05), experience of the endoscopist (more than 100 investigations versus less than 100 investigations; OR 0.54; P=0.05) and the existence of a malignant underlying disease (OR 2.28; P=0.019).

CONCLUSIONS: Similar to other endoscopic interventions, local infection as a complication of PEG tube placement depends on the experience of the endoscopist. Institutional factors also play a significant role. Additional risk factors include PEG tube size and underlying diseases. These findings indicate that the local infection after PEG tube placement may be influenced by both endoscopy-associated factors and by the underlying disease status of the patient.