Percutaneous endoscopic gastrostomy in patients with ventriculoperitoneal shunts

Background: Percutaneous endoscopic gastrostomy (PEG) may be required in ne urosurgical patients with a persistently depressed neurological status or s evere lower cranial nerve palsies. Such patients may have a coexisting hydr ocephalus requiring cerebrospinal fluid (CSF) diversion. Despite the risk o f infection resulting from exposure to oropharyngeal flora by the pull-thro ugh PEG technique and the secondary pneumoperitoneum seen in one-third of p atients, simultaneous peritoneal placement of CSF shunt catheters with PEG is the current practice. The aim of the study was to determine the frequenc y of CSF diversionary procedures in neurosurgical patients undergoing PEG i nsertion and the occurrence of infective complications in patients with sim ultaneous placement of a PEG and a ventriculoperitoneal (VP) shunt. Methods: This was a retrospective review of all neurosurgical patients unde rgoing PEG. The presence of hydrocephalus, mode of CSF diversion and the de velopment of subsequent infection in those having coexistent distal periton eal catheter placement and PEG were determined. Results: PEGs were placed in 42 neurosurgical patients (9.3 per cent of all PEGs inserted), of whom 21 had a coexisting hydrocephalus. Eight of 16 shu nts with distal catheter placement in the peritoneal cavity developed infec tion requiring revision. infections occurred with greater frequency in pati ents with a tracheostomy. There were no shunt infections requiring revision in a second group of 21 patients who had a coexisting shunt and tracheosto my without PEG. Conclusion: Simultaneous placement of a PEG and a VP shunt should be avoide d in the acute phase of a patient's hospital admission.