Reviewer's report
Title:Safety of pull-type and push-type percutaneous endoscopic gastrostomy
tubes in oncology patients: a retrospective analysis
Version: 1Date:19 December 2010
Reviewer: Arno J Dormann
Reviewer's report:
The article of van Dyck et al about "Safety of pull-type and push-type
percutaneous endoscopic gastrostomy tubes in oncology patients: a
retrospective analysis" is a retrospective analysis on 299 pts. in a 3 yrs period
(about 100 a yr).
Methods: The data are analysed on a no standardized retrospective background,
the population is mexed and not compared.
There is not evidence why the two groups can be comparable because the
push-type PEG placement with gastropexy (Freka ® Pexact Fr 15, Fresenius
Kabi AG, Bad Homburg, Germany) was only performed in case of high-grade
malignant stenosis, rendering the use of a conventional upper GI endoscope
impossible. This is the major problem in this study.
Results: Only 19% of the pts. were oncology pts. to evaluate the push-type PEG
placement with gastropexy (Freka ® Pexact Fr 15, Fresenius Kabi AG, Bad
Homburg, Germany). There is not clear what lead to pull and what to push-type
decision.
The antibiotic prophylaxis was not standardized and not clear what the decision
base was.
The complication rate in both groups especially severe complications is
extremely high (comparison lit.). Peristomal infections are not graded in severity
index and there is an extraordinary high rate of perforations (e.g. perforation of
the sigmoid and deaths) which might be due to the low experience of the teams.
Others did never report such high complication rates.
All this might be boosted by the lack of standardized FU (tube dislocation, wound
infection check, peritonitis, ingrown sutures which were not removed, no tube
change, no standard FU ...).
As another risk actor the authors did not state the time difference between PEG
procedure and chemotherapy which should be greater than 3-4 days minimum.
Discussion: The authors conclude that the push-type PEG placement with
gastropexy (Freka ® Pexact Fr 15, Fresenius Kabi AG, Bad Homburg, Germany)
carries a high risk of complications. This is totally in contrast to other publications
who have a great and long-time experience in this technique.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I had salary for some lectures in 2005and 2006 from Fresenius Kabi, no others
interests.
Reviewer's report
Title:Safety of pull-type and push-type percutaneous endoscopic gastrostomy
tubes in oncology patients: a retrospective analysis
Version: 1Date:19 December 2010
Reviewer: Arno J Dormann
Reviewer's report:
The article of van Dyck et al about "Safety of pull-type and push-type
percutaneous endoscopic gastrostomy tubes in oncology patients: a
retrospective analysis" is a retrospective analysis on 299 pts. in a 3 yrs period
(about 100 a yr).
Methods: The data are analysed on a no standardized retrospective background,
the population is mexed and not compared.
There is not evidence why the two groups can be comparable because the
push-type PEG placement with gastropexy (Freka ® Pexact Fr 15, Fresenius
Kabi AG, Bad Homburg, Germany) was only performed in case of high-grade
malignant stenosis, rendering the use of a conventional upper GI endoscope
impossible. This is the major problem in this study.
Results: Only 19% of the pts. were oncology pts. to evaluate the push-type PEG
placement with gastropexy (Freka ® Pexact Fr 15, Fresenius Kabi AG, Bad
Homburg, Germany). There is not clear what lead to pull and what to push-type
decision.
The antibiotic prophylaxis was not standardized and not clear what the decision
base was.
The complication rate in both groups especially severe complications is
extremely high (comparison lit.). Peristomal infections are not graded in severity
index and there is an extraordinary high rate of perforations (e.g. perforation of
the sigmoid and deaths) which might be due to the low experience of the teams.
Others did never report such high complication rates.
All this might be boosted by the lack of standardized FU (tube dislocation, wound
infection check, peritonitis, ingrown sutures which were not removed, no tube
change, no standard FU ...).
As another risk actor the authors did not state the time difference between PEG
procedure and chemotherapy which should be greater than 3-4 days minimum.
Discussion: The authors conclude that the push-type PEG placement with
gastropexy (Freka ® Pexact Fr 15, Fresenius Kabi AG, Bad Homburg, Germany)
carries a high risk of complications. This is totally in contrast to other publications
who have a great and long-time experience in this technique.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I had salary for some lectures in 2005and 2006 from Fresenius Kabi, no others
interests.
Please review this paper.
user
Reviewer's report
Title:Safety of pull-type and push-type percutaneous endoscopic gastrostomy
tubes in oncology patients: a retrospective analysis
Version: 1Date:19 December 2010
Reviewer: Arno J Dormann
Reviewer's report:
The article of van Dyck et al about "Safety of pull-type and push-type
percutaneous endoscopic gastrostomy tubes in oncology patients: a
retrospective analysis" is a retrospective analysis on 299 pts. in a 3 yrs period
(about 100 a yr).
Methods: The data are analysed on a no standardized retrospective background,
the population is mexed and not compared.
There is not evidence why the two groups can be comparable because the
push-type PEG placement with gastropexy (Freka ® Pexact Fr 15, Fresenius
Kabi AG, Bad Homburg, Germany) was only performed in case of high-grade
malignant stenosis, rendering the use of a conventional upper GI endoscope
impossible. This is the major problem in this study.
Results: Only 19% of the pts. were oncology pts. to evaluate the push-type PEG
placement with gastropexy (Freka ® Pexact Fr 15, Fresenius Kabi AG, Bad
Homburg, Germany). There is not clear what lead to pull and what to push-type
decision.
The antibiotic prophylaxis was not standardized and not clear what the decision
base was.
The complication rate in both groups especially severe complications is
extremely high (comparison lit.). Peristomal infections are not graded in severity
index and there is an extraordinary high rate of perforations (e.g. perforation of
the sigmoid and deaths) which might be due to the low experience of the teams.
Others did never report such high complication rates.
All this might be boosted by the lack of standardized FU (tube dislocation, wound
infection check, peritonitis, ingrown sutures which were not removed, no tube
change, no standard FU ...).
As another risk actor the authors did not state the time difference between PEG
procedure and chemotherapy which should be greater than 3-4 days minimum.
Discussion: The authors conclude that the push-type PEG placement with
gastropexy (Freka ® Pexact Fr 15, Fresenius Kabi AG, Bad Homburg, Germany)
carries a high risk of complications. This is totally in contrast to other publications
who have a great and long-time experience in this technique.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I had salary for some lectures in 2005and 2006 from Fresenius Kabi, no others
interests.
assistant