PTH-135 A Dedicated PEG Service Can Improve Mortality and Clinical Outcome

Abstract

IntroductionThe BSG guidelines1 recommend that every endoscopy unit in an acute hospital setting should provide a basic percutaneous endoscopic gastrostomy (PEG) service, which is a part of the nutritional support team. The service should provide a framework for patient selection, pre-assessment and post-procedural care as well as working closely with the community-based services. Our trust recently appointed an accredited therapeutic endoscopist and gastroenterology nurse practitioner to run this service.MethodsRetrospective analysis of all PEG insertions performed from Jan 2014 to Nov 2015 over a 23 month period. We looked at early-term (four weeks) and late term (eight weeks) mortality after PEG insertion.ResultsAll patients were referred via a revised pathway proforma and examined by the team before the procedure to assess suitability. Further help and advice is offered to the community team upon discharge. 71 patients were referred for PEG insertion during the period of study. 29 (41%) were male, with a mean age 68 (range 29–87 years), 42 (59%) were female, with a mean age 69 (range 18–93 years). Indications for referrals included: 37 (52%) stroke related dysphagia, 15 (21%) head and neck cancers, 6 (8.5%) Huntington’s disease, 4 (5.6%) traumatic head injury, 3 (4.2%) learning disability, 2 (2.8%) cerebral palsy, 2 (2.8%) multiple sclerosis, 1 (1.4%) supranuclear palsy, 1 (1.4%) mitochondrial myopathy, 1 (1.4%) syringomyelia, 1 (1.4%) parkinsonism, 1 (1.4%) Korsakoff’s psychosis, and 1 (1.4%) myoclonic epilepsy with ragged-red fibres (MERRF) syrdrome. Patients with a formal diagnosis of dementia were not selected to undergo PEG insertion during this period. No short-term complications were reported post-insertion.Early-term mortality was 12.7% and late-term rose to 22.5%. Previous departmental audit in 2014 revealed early-term mortality of 20% and late-term mortality of 28%.ConclusionMeta-analysis has reported a 19% 30 day mortality following PEG insertion. 3We have shown that in our centre, both early and late-term mortality has improved due to careful patient selection and a dedicated PEG service. Adherence to the BSG guidelines on PEG service has had a direct impact on improving mortality and clinical outcome.References1 Westaby D, Young A, O’Toole P, Smith G, Sanders DS. The provision of a percutaneously placed enteral tube feeding service. Gut. 2010;59:1592–1605. doi:10.1136/gut.2009.2049822 Johnston S, Tham T, Mason M. Death after PEG: results of the national confidential enquiry into patient outcome and death. Gastrointestinal Endoscopy 2008;68:223–7.3 Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci 2000;55:M735–9.Disclosure of InterestNone Declared

Do sociodemographic and clinical characteristics affect mortality rates in people with intellectual disability and dysphagia who have a percutaneous endoscopic gastrostomy? A cohort study between 2000 and 2022

“…Understanding who needs a PEG and when it should best be done are also important considerations. The use of a multidisciplinary team seems essential to a good outcome (Ayres et al, 2014) as does the provision of a dedicated PEG service working within the framework of a gastroenterology department and nutritional support team (Shirazi‐Nejad et al, 2016).…”

“…service working within the framework of a gastroenterology department and nutritional support team (Shirazi-Nejad et al, 2016).…”

Clinical Manifestations of Copper Deficiency: A Case Report and Review of the Literature

“…22 The severity of intestinal failure dictates treatment: enteral for mild or moderate disease and parenteral for severe disease. 21 Micronutrient and electrolyte alteration due to IBD, specifically Crohn's disease, are common because of the inflammatory nature of the disease that reduces absorptive capacity. Hypocupremia is a common but underdiagnosed finding in short-gut syndrome, and patients remain at risk when not given Cu-containing PN.…”

“…Intestinal failure is defined as the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that it necessitates IV supplementation to maintain health and/or growth. [21][22][23] The European Society of Clinical Nutrition and Metabolism classifies short-bowel syndrome as 1 of 5 major pathophysiological conditions of intestinal failure. 22 The severity of intestinal failure dictates treatment: enteral for mild or moderate disease and parenteral for severe disease.…”