Can Tuberculosis Patients Undergo Percutaneous Endoscopic Gastrostomy?

Q: Can Tuberculosis Patients Undergo Percutaneous Endoscopic Gastrostomy?

Dear readers：<br>Regarding the inquiry about whether patients with tuberculosis can undergo percutaneous endoscopic gastrostomy (PEG) surgery, the response is as follows：<br>1. <br>Transmission of tuberculosis：<br> (1) Historically, there have been theories regarding transmissi

Can patients with pulmonary tuberculosis undergo percutaneous endoscopic gastrostomy (PEG) placement?

Hello Doctor, my mother is 67 years old and has been diagnosed with tuberculosis in the lungs for the past three months, which has subsequently led to meningitis and abnormal behavior, requiring 24-hour care.
Recently, she has been unable to eat, so a nasogastric tube was inserted for feeding.
However, she has been uncomfortable and wants to remove it.
Based on suggestions from friends and family, we are considering a percutaneous endoscopic gastrostomy (PEG) to resolve this issue.
I would like to ask if a patient with tuberculosis can undergo a PEG procedure, and what precautions should be taken? Thank you.

leon, 30~39 year old female. Ask Date: 2018/01/26

Dr. Liao Zhongxin reply Internal Medicine

Dear readers:
Regarding the inquiry about whether patients with tuberculosis can undergo percutaneous endoscopic gastrostomy (PEG) surgery, the response is as follows:
1.
Transmission of tuberculosis:
(1) Historically, there have been theories regarding transmission through droplets, dust, and droplet nuclei, with droplet nuclei transmission being the most widely accepted.
Patients with active tuberculosis often expel the bacteria when they cough, speak, sing, or laugh in public places, releasing infectious droplets.
These droplets can dry and form nuclei that remain airborne, with those smaller than 5 μm capable of reaching the alveoli through the respiratory tract, leading to infection.
(2) Recently, the term airborne infection has been frequently used, emphasizing that infection can occur even at a considerable distance from the source, and should not be taken lightly.
However, another characteristic of tuberculosis infection is that it is difficult to contract, as the bacteria do not easily reach the distal parts of the lungs.
Transmission most commonly occurs among close contacts, often among individuals who are in close proximity or share living quarters.
Tuberculosis is generally not transmitted through clothing or utensils.
Direct inhalation of droplets expelled by an infected person is also a route of transmission.
2.
As long as the patient has received complete antibiotic treatment for tuberculosis, undergoing general surgery or examinations should not pose any issues.
Thank you!

Reply Date: 2018/01/26

More Info

When considering whether a tuberculosis (TB) patient can undergo a percutaneous endoscopic gastrostomy (PEG) procedure, several important factors must be taken into account. Your mother’s situation, particularly her recent diagnosis of pulmonary tuberculosis and subsequent complications, requires careful evaluation.

Understanding Tuberculosis and Its Implications
Tuberculosis is primarily a respiratory infection caused by the bacterium Mycobacterium tuberculosis. It spreads through airborne particles when an infected person coughs or sneezes. While the disease can affect various organs, including the lungs and the central nervous system (as in your mother’s case with meningitis), the primary concern for surgical procedures is the risk of infection and the patient’s overall health status.

Surgical Considerations for TB Patients
1. Infectious Status: If your mother is currently infectious, there is a risk of spreading the TB bacteria to healthcare workers and other patients in the hospital setting. It is crucial to ensure that she is on appropriate anti-TB medication and has been evaluated for her infectious status before any elective procedure like PEG.

2. Nutritional Status: Patients with TB often experience weight loss and malnutrition, which can complicate recovery from surgery. If your mother is unable to eat adequately and has been relying on a nasogastric tube for feeding, a PEG may be a suitable option to provide long-term nutritional support.

3. Immune Response: The immune system of a TB patient may be compromised, especially if they are undergoing treatment with immunosuppressive medications. This can increase the risk of postoperative infections. The surgical team will need to assess her overall health, including any other underlying conditions, before proceeding.

4. Timing of the Procedure: If your mother has recently been diagnosed with TB, it may be advisable to wait until she has been on treatment for a sufficient period and her symptoms have stabilized. This waiting period can help reduce the risk of complications.

Recommendations
- Consultation with Specialists: It is essential to involve a multidisciplinary team, including a pulmonologist, gastroenterologist, and possibly an infectious disease specialist, to evaluate the risks and benefits of performing a PEG in the context of her TB treatment.

- Monitoring and Follow-Up: If the PEG procedure is deemed appropriate, close monitoring will be necessary postoperatively to watch for any signs of infection or complications. This includes regular follow-ups to ensure that her TB treatment is effective and that she is recovering well from the surgery.

- Patient Education: Educating your mother and the caregivers about the signs of infection and the importance of adhering to her TB treatment regimen is crucial. This will help in managing her overall health and ensuring a successful outcome from the PEG procedure.

Conclusion
In summary, while it is possible for a tuberculosis patient to undergo a percutaneous endoscopic gastrostomy, it requires careful consideration of her infectious status, nutritional needs, and overall health. A thorough evaluation by a healthcare team is essential to make an informed decision. If the procedure is approved, diligent postoperative care and monitoring will be vital to ensure her safety and recovery. Always consult with her healthcare providers for personalized advice tailored to her specific medical condition.

Similar Q&A

Understanding Percutaneous Gastrostomy: A Guide to the Procedure

Hello, could you please provide me with information related to percutaneous endoscopic gastrostomy (PEG) procedure? Thank you.

Dr. Wu Bin'an reply Radiology
Percutaneous Gastrostomy (Gastrostomy) was initially performed surgically by surgeons, but with advancements in medical technology, this procedure can now be guided by endoscopy or fluoroscopy to create a stoma in the stomach through a percutaneous approach (Percutaneous Endoscop...

Seeking Transfer for Advanced Treatment of Pneumonia and Suspected Tuberculosis

Dear Director Yang, My grandfather is 89 years old. He was hospitalized on May 4 due to a fever, and tests indicated pneumonia with an inflammatory marker of over 7. His hemoglobin level was 7.8. He has been hospitalized since then (in a general ward) for treatment, which seems ...

Dr. Yang Wenda reply Pulmonology
Hello: Pneumonia and pulmonary tuberculosis cannot be distinguished from X-ray images, and the presence of pulmonary edema further complicates the differentiation between inflammation and fluid accumulation. This is also why it is challenging for clinicians to make a definitive d...

Post-Surgery Challenges for Colorectal Ulcer Patients: A Caregiver's Dilemma

Dear Dr. Yang, I would like to ask about my grandmother's condition. She is currently 78 years old and has been suffering from severe herpes zoster (commonly known as shingles) in her abdomen for the past two months, which has led to a loss of appetite. A month ago, due to ...

Dr. Yang Peizhen reply Gastroenterology and Hepatology
Hello: Typically, an endotracheal tube should be replaced every two weeks at most. If it is used beyond this period, the risk of infection increases, which can reduce the likelihood of successful extubation. Additionally, having the tube in the mouth for an extended period can be...

Understanding Gastrostomy Tubes: Temporary vs. Permanent and Feeding Challenges

Hello, my mother recently underwent a gastrostomy surgery at a hospital. It was an open surgery, not a percutaneous one. It has been a week since the surgery, and she still cannot receive tube feeding. I have a few questions: 1. Is there a distinction between temporary and perm...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
It is not possible to provide advice based on the information given; it is advisable to consult the attending physician to understand the situation.