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R E Falcone

Publications and source records attributed to R E Falcone.

56 records · Page 4Linked to original sources

Percutaneous endoscopic vs surgical gastrostomy.

The percutaneous endoscopic gastrostomy (PEG) has replaced the surgical gastrostomy (GT) on our service. We reviewed our data in an effort to determine relative efficacy and cost effectiveness of the two techniques. Thirty-five patients with PEGs were matched for age and diagnosis with 35 patients with GTs done by the same surgical service. PEGs were done in the endoscopy suite; GTs were done in the operating room: both under local anesthesia. Patients in PEG and GT groups were comparable in sex, diagnosis, and age. The PEG took less time to insert (15.3 vs 25.4 min, p less than 0.001). Major postoperative morbidity was similar with 10 systemic complications for each group and 11 deaths for the PEG vs 12 deaths for the GT group (at 90 days). Minor morbidity was higher for the PEG group with nine complications vs 1. Estimated cost for PEG was half the cost of GT. Hospital stay for the two groups was similar (36 vs 45 days, p greater than 0.1), but postop stay for the PEG group tended to be shorter (17 vs 24 days, p less than 0.08). The PEG is faster and cheaper to insert than the GT, however major morbidity and mortality are the same.

Anesthesia, General↗

An improved method for transpyloric placement of nasoenteric feeding tubes.

Post pyloric placement of small bore feeding tubes can be an elusive goal. Failure to achieve the post pyloric position can result in fatal complications. The following study presents a cost-effective, rapid technique for achieving post pyloric placement of feeding tubes utilizing gastric insufflation and right lateral decubitus positioning. Four study groups were identified. Group I utilized the new technique as first attempt (n = 21). Group 2 utilized the traditional, standard technique of insertion as first attempt (n = 20). Group 3 consisted of Group I failures after which the new technique was utilized (n = 19) Group 4 consisted of Group 3 failures after which the new technique was reattempted. Overall success rate of the new technique was 93%. This was highly significant with p < 0.0001. No significant difference was noted between inserters or type of tube used. The new technique described required no expensive equipment, minimal training and consistently allowed for transpyloric passage of the feeding tube.

Cost-Benefit Analysis↗