ABSTRACT

Objectives:

Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure with well-known efficacy and safety that is frequently used in patients who cannot be fed orally. In the literature, studies investigating long-term follow-up results in patients undergoing PEG are limited. In this study, we aimed to determine the long-term follow-up results and the factors affecting mortality in patients undergoing PEG.

Materials and Methods:

Two hundred and three patients who underwent PEG placement between January 2013 and June 2018 were evaluated retrospectively. The demographic characteristics of the patients, postoperative follow-up times, complications, PEG indications, laboratory parameters during the procedure were recorded from the patient files. During the follow-up period, the mortality and time of the patients were determined via the death notification system.

Results:

A total of 203 patients (101 male, 102 female) were included in the study. The median age of the patients was 77 years (18-96). The most frequent PEG placement indication was stroke with a frequency of 34%, followed by dementia (28.6%), malignancy (10.8%) and other (15.8%) reasons. The median follow-up period was 33.6 months (30.5-36.7) and the median survival was 22 months [95% confidence interval (CI): 22.8-30.5]. Mortality rates were 1.5% in the first month, 3% in 3 months, 12.3% in 1 year, 26.6 years in 2 years, 34.5% in 3 years and 44.3% in 5 years. There was no correlation between PEG indications and mortality, but there was a statistically significant correlation between hyponatremia and mortality (Odds ratio: 1.07, p=0.027, %95 CI).

Conclusion:

There was no statistically significant relationship between PEG placement indications and mortality, but there was a statistically significant correlation between hyponatremia and mortality.

Keywords: Percutaneous Endoscopic Gastrostomy, Mortality, Follow-up Results

References

Gauderer WL, Ponsky JL, İzant RJ. Gastrostomy without laparatomy: a percutaneous endoscopic technique. J Pediatry Surg. 1980;15:872-875.

Ponsky JL, Gauderer MW, Stellato TA. Percutaneous endoscopic gastrostomy. Review of 150 cases. Arch Surg. 1983;118:913-914.

Lucendo AJ, Friginal-Ruiz AB. Percutaneous endoscopic gastrostomy: An update on its indications, management, complications, and care. Rev Esp Enferm Dig. 2014;106:529-539.

Hucl T, Spicak J. Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol. 2016;30:769-781.

Friginal-Ruiz AB, Lucendo AJ. Percutaneous Endoscopic Gastrostomy: A Practical Overview on Its Indications, Placement Conditions, Management, and Nursing Care. Gastroenterol Nurs. 2015;38:354-366

Nair S, Hertan H, Pitchumoni CS. Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia. Am J Gastroenterol. 2000;95:133-136.

Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci. 2000;55:735-739.

Finocchiaro C, Galletti R, Rovera G, et al. Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition. 1997;13:520-523.

Amann W, Mischinger HJ, Berger A, et al. Percutaneous endoscopic gastrostomy (PEG). 8 years of clinical experience in 232 patients. Surg Endosc. 1997;11:741-744.

McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ. 1994;308:945-948.

Heyland DK. Nutritional support in the critically ill patient: a critical reviewof the evidence. Crit Care Clin. 1998;14:423-440.

Braunschweig CL, Levy P, Shehan PM, et al. Enteral compared with parenteral nutrition: a meta–analysis. Am J Clin Nutr. 2001;74:534-542.

DeLegge MH. Enteral Access and Associated Complications. Gastroenterol Clin North Am. 2018;47:23-37.

Roche V. Percutaneous endoscopic gastrostomy. Clinical care of PEG tubes in older adults. Geriatrics. 2003;58:22-29.

Grant DG, Bradley PT, Pothier DD, et al. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol. 2009;34:103-112.

Rimon E, Kagansky N, Levy S. Percutanous endoscopic gastrostomy; evidence of different prognosis in various patients subgroups. Age Ageing. 2005;34:353-357.

Richter-Schrag HJ, Richter S, Ruthmann O, et al. Risk factors and complications following percutaneous endoscopic gastrostomy: a case series of 1041 patients. Can J Gastroenterol. 2011;25:201-206.

Light VL, Slezak FA, Porter Gerson LW, et al. Predictive factors for early mortality after percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1995;42:330-335.

Zopf Y, Maiss J, Konturek P, et al. Predictive factors of mortality after PEG insertion: guidance for clinical practice. JPEN J Parenter Enteral Nutr. 2011;35:50-55.

Callahan CM, Haag KM, Weinberger M, et al. Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc. 2000;48:1048-1054.

Kara O, Kizilarslanoglu MC, Canbaz B, et al. Survival After Percutaneous Endoscopic Gastrostomy in Older Adults With Neurologic Disorders. Nutr Clin Pract. 2016;31:799-804.

Schurink CA, Tuynman H, Scholten P, et al. Percutaneous endoscopic gastrostomy: complications and suggestions to avoid them. Eur J Gastroenterol Hepathol. 2001;13:819-823.

Sanders DS, Carter MJ, D’Silva J, et al. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol. 2000;95:1472-1475.

Pih GY, Na HK, Ahn JY, et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion. BMC Gastroenterol. 2018;18:101.

Long-term Follow-up Results of Patients with Percutaneous Endoscopic Gastrostomy and Factors Affecting Survival

ABSTRACT

References