Gastrostomia endoscópica percutânea pela técnica de inserção modificada de Hashiba: descrição e comparação com a técnica de tração de Ponsky

Abstract

After the original description by Gauderer, Ponsky and Izant, percutaneous endoscopic gastrostomy (GEP) has been indicated for patients with a functioning gastrointestinal tract, who will need prolonged enteral feeding. The Ponsky traction technique, currently used, has a low incidence of complications, some of them due to the suture of the stomach to the abdominal wall and the contamination of the tube when it passes through the oral cavity. The modified Hashiba insertion technique, performed with gastropexy and without contamination of the tube with oropharyngeal secretion, also has a small rate of complications. Objective: The aim of this study was to present the HEPP technique by modified insertion of Hashiba, analyzing its effectiveness, material costs, procedure time and frequency of complications in comparison with the Ponsky traction technique. Methods: 47 patients with neurological diseases or partial obstruction of the air-digestive tract and life expectancy greater than thirty days were randomized into two groups: 23 for the Ponsky traction technique (group I) and 24 for the modified insertion technique Hashiba (group II). Antibiotic prophylaxis was performed only in patients in group I. Re-analyzes were performed after 10, 30, 90 and 180 days from the date of the procedure. Upon entry into the study, both groups were similar in age, underlying disease, and serum hemoglobin and albumin levels. The mean time of the procedure was 15.6 +/- 3.6 minutes in group I, and 19.6 +/- 4.5 minutes in group H (p = 0.003). There were three deaths in each group, but only in group I they were related to the procedure. Three major complications (13.04%) were found in group I and none in group D (p = 0.11). Minor complications occurred in seven patients (30.4%) in group I and in four (16.5%) in group II (p = 0.27). Adding the major and minor complications, there are ten patients (43.4%) in group I and four (16.5%) in group II (p = 0.045). Six patients (25%) in group II and two (8.6%) in group I required replacement or maintenance of the probe (p = 0.24). The values ​​of the specific materials used were US $ 292.65 per xiprocedure in group I and US $ 11.94 in group II. Conclusions: GEP using the modified Hashiba insertion technique is effective and, in relation to the Ponsky traction technique, it has a lower incidence of complications, has a lower cost of materials and requires a few more minutes for its execution.