Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion

Pih, Gyu Young; Na, Hee Kyong; Ahn, Ji Yong; Jung, Kee Wook; Kim, Do Hoon; Lee, Jeong Hoon; Choi, Kee Don; Song, Ho June; Lee, Gin Hyug; Jung, Hwoon‐Yong

doi:10.1186/s12876-018-0825-8

Cited by 76 publications

(68 citation statements)

References 33 publications

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“…In fact, a survival comparison study by Malmgren et al after PEG insertion in 191 older adults with different medical conditions found patients with dementia or Parkinson's disease have longest median survival times (244 and 233 days, respectively) compared with patients that had amyotrophic lateral sclerosis and malignancy of head and neck who had shortest median survival times of 75 and 106 days, respectively [123]. One recently published (Pih et al) study also reports that patients with neurologic disease including dementia have much lower incidence of 30-day mortality post-PEG compared with patients with stroke and malignancy [124]. It is important to mention that this review could not establish whether the included dementia patients in the studies of Malmgren et al and Pih et al had moderately severe or advanced dementia illness as the patients' dementia stages were not specified.…”

Section: Articlementioning

confidence: 99%

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

Ijaopo

2019

Journal of Aging Research

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Background. Dementia remains a growing concern for societies globally, particularly as people now live longer. About 90% of individuals with advanced dementia suffer from eating problems that lead to general health decline and ultimately impacts upon the physical, psychological, and economic wellbeing of the individuals, caregivers, and the wider society. Objective. To evaluate the burdens and perceived benefits of tube feeding in individuals with advanced dementia. Design. Narrative review. Methods. Computerized databases, including PubMed, Embase, Medline, CINAHL, PsycInfo, and Google Scholar were searched from 2000 to 2019 to identify research papers, originally written in or translated into English language, which investigated oral versus tube feeding outcome in individuals with advanced dementia. Results. Over 400 articles were retrieved. After quality assessment and careful review of the identified articles, only those that met the inclusion criteria were included for review. Conclusion. Tube feeding neither stops dementia disease progression nor prevents imminent death. Each decision for feeding tube placement in individuals with advanced dementia should be made on a case-by-case basis and involve a multidisciplinary team comprising experienced physicians, nurses, family surrogates, and the relevant allied health professionals. Careful considerations of the benefit-harm ratio should be discussed and checked with surrogate families if they would be consistent with the wishes of the demented person. Further research is required to establish whether tube feeding of individuals with advanced dementia provides more burdens than benefits or vice-versa and evaluate the impacts on quality of life and survival.

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Section: Articlementioning

confidence: 99%

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

Ijaopo

2019

Journal of Aging Research

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“…The use of 30-day mortality to assess the safety of gastrostomy procedures is commonplace,16 17 probably reflecting a traditional ‘end point’ for surgical procedures. Our data demonstrate that both PEG and gastropexy-facilitated gastrostomy have low 30-day mortality rates and a low incidence of serious procedure-related complications.…”

Section: Discussionmentioning

confidence: 99%

Gastropexy can be as safe as conventional percutaneous endoscopic gastrostomy (PEG), and biomarkers do not predict short-term or long-term outcomes: a 7-year follow-up audit

Porter

McKinlay

Metcalfe

2019

Frontline Gastroenterol

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ObjectiveGastrostomy facilitates artificial enteral feeding but controversy exists around associated morbidity and mortality. This study aimed to report short and long-term outcomes, and identify parameters associated with overall survival.MethodsA 7-year follow-up audit was undertaken at Aberdeen Royal Infirmary, UK. All patients undergoing endoscopic gastrostomy insertion October 2011–September 2018 were included. Last follow-up was February 2019. Clinical data were prospectively collected. Blood results were retrospectively obtained from electronic records. Statistical analysis was with IBM SPSS V.25.Results691 procedures were performed over the 7-year period (520 traditional pull-through percutaneous endoscopic gastrostomy (PEG) and 171 gastropexy procedures to facilitate gastrostomy). Frequency of complications (gastrointestinal bleeding, perforation and peritonitis) was low (each n=1). Overall 7-day and 30-day mortality was 2.2% and 8.4%, respectively. One-year mortality reached 47.6%. There was no difference in survival between PEG and gastropexy procedures (p=0.410). Multivariate analysis reported increased age (p<0.001), increased alkaline phosphatase (p<0.001) and clinical indication (p=0.002) as independently associated with an increased hazard of death. Only age was moderately predictive of mortality (area under the curve 0.74, 95% CI 0.70 to 0.78, p<0.001) in the PEG group. Clinical indication was the only parameter independently associated with mortality in the gastropexy cohort (p=0.003).ConclusionEndoscopic gastrostomy placement can be safe with a low mortality and low risk of serious complications. Blood markers were not associated with short-term or long-term outcomes. Gastropexy to facilitate gastrostomy is a safe alternative to traditional pull-through PEG procedures. Future work should consider quality of life outcomes to assess the benefit of gastrostomy from a patient perspective.

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“…PEG takılma endikasyonları arasında ilk sırayı yutma disfonksiyonuna yol açan kronik nörolojik hastalıklar almaktadır. Baş boyun travmaları, tümörleri, üst hava yolları cerrahisi diğer nedenler arasındadır (1)(2)(3)5 (6,7,24). Bizim çalışmamızda hiponatremi ile mortalite arasında istatistiksel olarak anlamlı bir ilişki saptanmıştır (%95 CI, p=0,027).…”

Section: Discussionunclassified

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

Aksoy¹,

Sapmaz²,

Akpınar³

et al. 2019

atfm

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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.

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Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion

Cited by 76 publications

References 33 publications

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

Gastropexy can be as safe as conventional percutaneous endoscopic gastrostomy (PEG), and biomarkers do not predict short-term or long-term outcomes: a 7-year follow-up audit

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

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