ABSTRACT
The lumen of gastrostomy tubes is frequently colonized with Candida. To investigate the source of this contamination, 20 consecutive malnourished patients undergoing placement of a percutaneous endoscopic gastrostomy tube and ten ambulatory controls having routine upper endoscopy performed had both their oral cavity and gastric antrum swabbed and cultured. Percutaneous endoscopic gastrostomy tube recipients who after several weeks were still under our care (9 of 20) had the lumen of their tubes cultured. Fungi were isolated from the stomach in 13 (65%) of 20 patients undergoing percutaneous endoscopic gastrostomy tube placement but in only 1 of 10 ambulatory patients (p < .01). The species isolated from the oral cavity, the stomach, and later the gastrostomy tube were identical in most cases. We conclude that gastrostomy tubes are probably colonized by oral organisms that have made their way into the stomach.
Subject(s)
Candida/isolation & purification , Equipment Contamination , Intubation, Gastrointestinal/instrumentation , Mouth/microbiology , Aged , Endoscopy , Gastrostomy , Humans , Middle Aged , Nutrition Disorders/therapy , Stomach/microbiologyABSTRACT
Ten patients developed apnea or cardiopulmonary arrest during or following endoscopy in more than 10,000 consecutive endoscopies. These complications occurred in patients over the age of 60 years with many associated diseases. Four of the reactions occurred close to the time of giving intravenous medication, the majority after the stimulation of the procedure had ended, usually more than 30 min after the last dose of medication. The initial 7,500 procedures were conducted without automated monitoring, but the most recent 2,500 procedures employed finger pulse oximetry. Monitoring has not prevented apnea and cardiopulmonary arrest, but it provides earlier recognition.
Subject(s)
Apnea/etiology , Endoscopy, Gastrointestinal/adverse effects , Heart Arrest/etiology , Aged , Apnea/epidemiology , Butorphanol/adverse effects , Databases, Factual , Diazepam/adverse effects , Heart Arrest/epidemiology , Humans , Male , Meperidine/adverse effects , Midazolam/adverse effects , Middle Aged , Monitoring, Physiologic/methods , Oximetry , Risk FactorsABSTRACT
Silicone rubber PEG tubes or replacements were recovered from 111 patients and examined for blockage, dilatations, tears, breaks, or loss of elasticity. All irregularities were stained and examined for fungus using lactophenol cotton blue stain. The intraabdominal portion of the PEG failed from obstructions, loss of elasticity, or tears related to fungus colonies in 36% of cases. An additional 34% were colonized with fungi but did not fail. On frozen section, the fungus invaded the wall of the tubing. The extraabdominal PEG tubing failed from fungi in 12, and 10 additional tubes had colonizations. Nine tubes had distal clogging with crystalline material that is believed to arise from medication. Fungus tube failure occurred in 37% of the tubes in place 250 days and in 70% of tubes in place 450 days. Fungus is an important cause of PEG failure; recommendations are provided to maintain tube patency.
Subject(s)
Equipment Contamination , Fungi/isolation & purification , Gastrostomy/instrumentation , Intubation/instrumentation , Silicone Elastomers , Endoscopy , Equipment Failure , Humans , PuncturesABSTRACT
Breath hydrogen and methane concentrations were normal before morning colonoscopy in 72 ambulatory patients randomly assigned to Ensure or clear liquid diet preparation for 48 hours. Mechanical bowel preparation was equal with each diet using an evening-laxative and morning-enema regimen and with Ensure using two consecutive evenings of laxatives without enemas. Ensure is an explosion-safe, mechanically acceptable, nutritionally adequate method of colonoscopy preparation. With a suitable laxative, Ensure eliminates the need for enemas in colonoscopy preparation.