Abstract
Background
Percutaneous endoscopic gastrostomy (PEG) is the most common endoscopic procedure
used to provide nutritional support.
Aim
To prospectively evaluate the mortality and complication incidences after PEG insertion
or replacement.
Methods
All patients who underwent PEG insertion or replacement were included. Details on
patient characteristics, ongoing therapies, comorbidities, and indication for PEG
placement/replacement were collected, along with informed consent form signatures.
Early and late (30-day) complications and mortality were assessed.
Results
950 patients (47.1% male) were enrolled in 25 centers in Lombardy, a region of Northern
Italy. Patient mean age was 73 years. 69.5% of patients had ASA status 3 or 4. First
PEG placement was performed in 594 patients. Complication and mortality incidences
were 4.8% and 5.2%, respectively. The most frequent complication was infection (50%),
followed by bleeding (32.1%), tube dislodgment (14.3%), and buried bumper syndrome
(3.6%). At multivariable analysis, age (OR 1.08 per 1-year increase, 95% CI, 1.0–1.16,
p = 0.010) and BMI (OR 0.86 per 1-point increase, 95% CI, 0.77−0.96, p = 0.014) were
factors associated with mortality.
PEG replacement was carried out in 356 patients. Thirty-day mortality was 1.8%, while
complications occurred in 1.7% of patients.
Conclusions
Our data confirm that PEG placement is a safe procedure. Mortality was not related
to the procedure itself, confirming that careful patient selection is warranted.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).JPEN J Parenter Enteral Nutr. 2009; 33: 277-316
- Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances.Cochrane Database Syst Rev. 2016; 2 (CD009198)
- Comparison of complication rates between endoscopic and fluoroscopic percutaneous gastrostomies.Nutrition. 2001; 17: 967-968
- Gastrostomy without laparotomy: a percutaneous endoscopic technique.J Pediatr Surg. 1980; 15: 872-875
- Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE).Gastroenterology. 2011; 141: 742-765
- Risk factors for complications and mortality of percutaneous endoscopic gastrostomy: a multicenter, retrospective study.Surg Endosc. 2013; 27: 3806-3815
- Risk factors and complications following percutaneous endoscopic gastrostomy: a case series of 1041 patients.Can J Gastroenterol. 2011; 25: 201-206
- Predictive factors of mortality after PEG insertion: guidance for clinical practice.JPEN J Parenter Enteral Nutr. 2011; 35: 50-55
- Complications of percutaneous endoscopic gastrostomy.Best Pract Res Clin Gastroenterol. 2016; 30: 769-781
- Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment.JAMA. 2003; 290: 73-80
- Appropriate use of artificial nutrition and hydration—fundamental principles and recommendations.N Engl J Med. 2005; 353: 2607-2612
- Factors predicting early discharge and mortality in post-percutaneous endoscopic gastrostomy patients.Ann Gastroenterol. 2014; 27: 42-47
- Percutaneous endoscopic gastrostomy in cancer patients: predictors of 30-day complications, 30-day mortality, and overall mortality.Dig Dis Sci. 2013; 58: 768-776
- Utility of three prognostic risk scores in predicting outcomes in elderly non-malignant patients after percutaneous gastrostomy.J Nutr Health Aging. 2017; 21: 1344-1348
- Severe hypernatremia as a predictor of mortality after percutaneous endoscopic gastrostomy (PEG) placement.Dig Liver Dis. 2017; 49: 181-187
- Comparison of complications between endoscopic and percutaneous replacement of percutaneous endoscopic gastrostomy tubes.J Korean Med Sci. 2013; 28: 1781-1787
- To pull or to scope: a prospective safety and cost-effectiveness of percutaneous endoscopic gastrostomy tube replacement methods.J Clin Gastroenterol. 2018;
- Risk factors for complications of percutaneous endoscopic gastrostomy.Dig Dis Sci. 2014; 59: 117-125
Article info
Publication history
Published online: April 19, 2019
Accepted:
March 25,
2019
Received:
October 9,
2018
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
