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 24 May 2018

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News

Pneumoperitoneum after PEG placement is common

The latest Gastrointestinal Endoscopy suggests that pneumoperitoneum after Percutaneous Endoscopic Gastrostomy occurs often, but is not significance in the absence of symptoms.

News image

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Percutaneous Endoscopic Gastrostomy (PEG) is a widely used method for providing nutritional support.

Although pneumoperitoneum is a known finding after Percutaneous Endoscopic Gastrostomy placement, its true incidence is subject to debate.

Small retrospective studies have found varied rates of free air after Percutaneous Endoscopic Gastrostomy placement.

There were a total of 65 patients.

Dr Ari Wiesen and colleagues from New York assessed the true incidence of pneumoperitoneum and its clinical significance.

No adverse events were associated with PEG placement
Gastrointestinal Endoscopy

The investigators obtained upright and anterior-posterior chest radiographs of 65 patients within 3 hours after Percutaneous Endoscopic Gastrostomy placement.

Type of Percutaneous Endoscopic Gastrostomy tube, gauge of the needle used, number of sticks, and indications were recorded.

The team evaluated the presence of pneumoperitoneum on the initial chest film was considered to be a positive finding.

After a positive result, a repeat chest film was obtained 72 hours later to determine whether there was progression or resolution of the free air.

The investigators monitored patients enrolled clinically for evidence of peritonitis.

Of the 65 patients who underwent Percutaneous Endoscopic Gastrostomy placement, 13 developed a pneumoperitoneum on the initial chest radiograph.

The investigators observed that there was complete resolution of pneumoperitoneum at 72 hours in 10 of the 13 patients.

In 3 patients, the free air persisted but was of no clinical significance.

The team quantified the free air by measuring the height of the air column under the diaphragm and was graded with a scoring system.

The team reported that 11 patients who underwent Percutaneous Endoscopic Gastrostomy died during the hospitalization.

The investigators noted that none of the deaths were related to the Percutaneous Endoscopic Gastrostomy placement or pneumoperitoneum.

The other 54 patients were discharged to a skilled nursing facility.

The team found that none of the patients in the study had clinical evidence of peritonitis.

There were no adverse events, such as, infection or bleeding, associated with the Percutaneous Endoscopic Gastrostomy placement in any of the patients.

Dr Wiesen's team concludes, “Our data suggest that pneumoperitoneum after Percutaneous Endoscopic Gastrostomy placement is common.”

“In the absence of clinical symptoms, it is of no clinical significance and does not warrant any further intervention.”

Gastrointest Endoscopy 2006: 64(6): 886-9
13 December 2006

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