SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2021 | VOLUME 19 | ISSUE 2 | 42 Background: Patients with a functional gastrointestinal tract requiring long term enteral feeding may benefit from the placement of a percutaneous endoscopic gastrostomy (PEG) tube. The aim of this retrospective audit was to evaluate the indications and technical success of PEG tube insertions at Groote Schuur Hospital. Materials and Method: A single unit retrospective audit was performed on patients referred for PEG insertion. Patient demographics included age, sex, comorbidities, and body mass index (BMI). PEG tube indication, immediate technical success, early complications (within 30 days), presence of risk factors for insertion and complications as well as management thereof where evaluated. Results: Forty-six patients were referred for a PEG. Of these, 44 patients had a successful PEG insertion (in two patients referred for PEG, obstructing tumour and abdominal adiposity precluded safe placement). The most prevalent indications were nasopharyngeal malignancy (n=13, 28.3%), followed by bulbar palsy (n=8, 17.4%). Three insertions (6.82%) had an immediate complication (two laryngospasms and a nasopharyngeal tumour bleed; managed conservatively) and 11 insertions (25%) had an early complication (within 30 days). Early complications included 4 mild PEG-site infections and 3 minor leaks, all managed conservatively. Two accidental removals and one early buried bumper syndrome necessitated endoscopic reintervention. A single high output leak occurred in a cachectic patient with metastatic nasopharyngeal carcinoma. Due to the overall poor performance status of this patient, the management was conservative with death 4 days post PEG placement. Patients in the lower BMI spectrum tended to have the leaks, while abdominal obesity remains a risk for insertion site infection. Conclusion: Early complication rates in our setting are high. Fortunately, most early complications are successfully managed conservatively. It is the very low and high BMI patients that appear most at risk. Technical ease of insertion should not undermine careful evaluation of risk versus benefit of PEG placement in high-risk patients. Indications and technical success of Percutaneous Endoscopic Gastrostomy tube placement at Groote Schuur Hospital B Gibson 1 , M Scriba 2 , A du Toit 3 , E Jonas 2 , G Chinnery 2 Department of Surgery, Grey’s Hospital 1 , Department of Surgery 2 and Department of Dietetics 3 , Groote Schuur Hospital A descriptive study of Crohn’s disease at a quaternary referral hospital in KwaZulu-Natal, South Africa C Gounden 1 , VG Naidoo 1 , KA Newton 1 , TE Madiba 2 Department of Gastroenterology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal 1 , Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal 2 Introduction Crohn’s disease (CD) is a lifelong condition that leads to poor quality of life from debilitating complications. Aim To describe the demographic, clinical characteristics and disease outcome in patients with CD in KwaZulu-Natal, an area with a paucity of existing data on the condition. Methods A retrospective chart review of patients diagnosed with CD attending Inkosi Albert Luthuli Central Hospital from 2003 to 2019 was undertaken. Data collected included demographics, clinical presentation, management and follow-up. Data and clinical variables were extrapolated from the password-protected hospital information management system and analysed using Microsoft excel. Ethical approval was obtained from the Biomedical Research Ethics Committee of UKZN (Ref.:BE502/16). Results One hundred and thirty-six patients with CD were identified. Race groups were 78 Indian (57%), 35 White (26 %) and 13 Black (10 %). M:F ratio was 1:1.6. Diagnosis was mainly between age 17- 40 years (87; 64%) [median 30 years (IQR 23-40)]. Most patients presented with abdominal pain (75; 55%); ileo-colonic (L3: 87; 64%) location; non-stricturing/non penetrating (B1: 72; 53%) behaviour and anaemia (43; 32%). Arthritis (peripheral and axial) (20; 15%) was the most common extraintestinal manifestation. Most patients were treated with corticosteroids (86; 63%) and immunomodulators (96; 70.5%). Eighty-two (60%) patients required surgery mainly for complicated disease behaviour [strictures (34; 40%) and fistulae (25; 18%)] at a median time from diagnosis of 1 year (IQR 0.9-9). Median follow-up was 60 months (IQR 18-105) and death occurred in 8 (6%). Discussion Age at diagnosis, disease location and gender were similarly reported in Asia and Western Cape. Equal distributions for disease location (ileal, colonic, ileo-colonic) have been reported in high- income countries. Early surgical referral for complicated behaviour contrasts with lower rates reported in high-income countries Conclusion Findings confirm an increasing trend of CD diagnosis among Blacks. There was a high surgery referral rate at a short time from diagnosis for complicated disease behaviour. SAGES