[Percutaneous endoscopic gastrostomy: analysis of practice at the endoscopic center of tertiary medical care]. / Perkutánní endoskopická gastrostomie: analýza praxe v endoskopickém centru terciární lékarské péce.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive routine procedure used to provide long-term enteral nutrition in selected patients with impaired oral intake. The knowledge of clinical, technical and safety features of PEG is an important issue in clinical practice.The aim of this study was to evaluate the popu-lation of patients selected for PEG insertion, describe certain aspects of the insertion procedure, assess the service life of PEG, as well as account for the number of complications and patient mortality in the six-month period following the procedure. METHODS: We used a retrospective analysis of data from medical database. The data were collected in a single endoscopic tertiary-referral center for a period of seven and a half years. RESULTS: We evaluated 326 PEG insertions performed on 292 patients with a median age of 63 years (IQR 55-70). Mortality in the six-month period following PEG insertion was 26 %. Prevailing indications for PEG insertion were oncological (53 %) and neurological (40 %) diseases, with certain fluctuation of these numbers during the observed period according to changing demands of the two medical specialties. Local anesthesia alone was applied in 56 % of patients, 38 % underwent analgosedation and 6 % required general anesthesia. Median duration of the procedure (from insertion of endoscope to its final extraction) in 68 consecutive procedures was 6 minutes (IQR 5-8). Median interval between PEG introduction and its first replacement in 21 patients was 22 months (IQR 14-31, range 4-76). 61 patients underwent PEG extraction during the observed period, 66 % of whom had oncological disease. Periprocedural complications were seen in 5.8 % of patients, of these one patient (0.3 %) suffered a serious complication. The buried bumper syndrome was observed in four patients (1.2 %), all of whom had neurological disease. CONCLUSIONS: PEG is a relatively safe procedure and can be performed in a short time using local anesthesia or analgosedation in a majority of patients. The population of patients indicated for PEG insertion reflects primarily the current needs of neurological and oncological departments. Most patients within the observed group benefit from PEG insertion for more than six months. KEY WORDS: analgosedation - complications - mortality - percutaneous endoscopic gastrostomy.

[Biological therapy in women with inflammatory bowel disease during pregnancy]. / Biologická terapie u pacientek s idiopatickými strevními zánety v gravidite

The aim of this article is to objective review available research data regarding the safety of biological therapies during pregnancy and breastfeeding in women with inflammatory bowel disease. Biological therapies appear to be safe in pregnancy, as no increased risk of malformations has been demonstrated. Available clinical results suggest that the efficacy of infliximab and adalimumab in achieving clinical response and maintaining remission in pregnant patients might outweigh the theoretical risks of drug exposure to the fetus. If possible, anti-TNF therapy should be stopped by the end of the second trimester due to transplacental transfer and potential risk for the fetus. The use of infliximab and adalimumab is probably compatible with breastfeeding.