Prevalence and Trends in Percutaneous Endoscopic Gastrostomy Placement: Results From a 10-Year, Nationwide Analysis

Abstract

BackgroundPercutaneous endoscopic gastrostomy (PEG) is the most commonly used access for long-term enteral nutrition. Only a few studies report the prevalence and epidemiology of PEG placements. No previous data concentrated on the healthcare system issues influencing the qualification rates and professional nutritional support for individuals with PEG.MethodsWe conducted a retrospective nationwide analysis of PEG placements in Poland from 2010 to 2020. The central data on ICD-10 coding of adult patients with PEG reported to the insurance company were used for the analysis of general and regional prevalence, age, and primary and secondary diseases. Rates of patients with home enteral nutrition (HEN) were calculated with a special focus on patients with cancer. A secondary aim was to determine the causes of regional disparities among administrative regions.ResultsA total number of 90,182 PEGs were placed during the observation period. The number was increasing each year with statistical significance. Malnutrition, dysphagia, and cardiorespiratory/metabolic diseases were the most frequently reported primary diseases. A total of 11.98% of all patients were diagnosed with cancer; 49.9% of oncological patients suffered from head and neck cancer (HNC) and 19.9% from esophageal cancer. In total, 6.61% of HNC and 27.46% of patients with esophageal cancer from the Polish National Cancer Registry (NCR) had PEG. The rates of patients in more advanced ages (65–74 and over 85 years) were growing and decreased in younger groups (18–24, 45–54, and 55–64 years). Overall, 27.6% of all (11.86% of cancer) patients with PEG were reimbursed HEN. A high number of patients in nursing care facilities, lower education of citizens, and lower number of hospital beds were associated with more PEG insertions in the administrative regions.ConclusionThe number of PEG placements has been increasing, particularly in the elderly. Systemic solutions must be found to address the problems of regional disparities in PEG’s prevalence as well as the lack of inclusion criteria for nutritional support.

Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades

“…We believe that this mirrors the international shift towards more minimally invasive procedures[ 17 ]. Very few studies have examined the number of gastrostomy placements in other countries, but the observed doubling of PEG is similar to the 2.5-fold increase observed in Poland from 2010-2020[ 18 ]. The United States experienced an exponential increase in PEG use from 1980-2000, resulting in more than 216000 annual PEGs[ 19 ].…”

“…In a prospectively collected case series of 1041 PEG patients in Germany, the most common indication was neurogenic dysphagia (43%), followed by cancer (37%)[ 22 ]. In the previously mentioned Polish PEG study[ 18 ], where indication was also based on ICD-10 codes, the most common indication was dysphagia and malnutrition (37.2%), which as the author states might have been a consequence of other diseases. The high proportion of non-malignant gastrointestinal conditions in this study was due to perioperative placement of a gastrostomy for stomach decompression in the case of emergency surgery.…”

Deconstructing the steps of pull-type PEG tube insertion

“…Despite the benefits associated with PEG feeding, there is a disparity in its widespread adoption because of the risk of adverse events and lack of expertise to perform PEG. 4 , 5 , 6 This instructional video ( Video 1 ), deconstructs the steps for performing pull-type PEG.…”