Simple Bedside Predictors of Survival after Percutaneous Gastrostomy Tube Insertion

Sbeit, Wisam; Kadah, Anas; Mari, Amir; Mahamid, Mahmud; Khoury, Tawfik

doi:10.1155/2019/1532918

Cited by 8 publications

(8 citation statements)

References 20 publications

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“…Furthermore, low BMI as a risk factor for mortality at 90 days also indicate that many of our patients would beneft from PEG at an earlier stage of their disease, since the indication for PEG in many cases is to achieve suffcient nourishment. Our fnding that higher CRP levels are associated with worse outcomes is not surprising, has been shown in previous studies, and should be considered an indication of a more severe underlying condition [15,17,22,23]. Te fnding that underlying diabetes and heart failure increases the risk of mortality has also been confrmed in previous studies [20,21,23].…”

Section: Discussionsupporting

confidence: 72%

Mortality and complications after percutaneous endoscopic gastrostomy, a retrospective multicentre study

Stenberg¹,

Eriksson²,

Odensten

et al. 2022

Preprint

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Background: Percutaneous endoscopic gastrostomy (PEG) is the method of choice for patients in need of long-term nutritional support or gastric decompression. Although it is considered safe, complications and relatively high mortality rates have been reported. We aimed to identify risk factors for complications and mortality after PEG in routine healthcare.Methods: This retrospective study included all adult patients who received a PEG between 2013 and 2019 in Region Norrbotten, Sweden.Results: 389 patients were included. The median age was 72 years, 176 (45%) were women and 281 (72%) patients received their PEG due to neurological disease. All-cause mortality was 15% at 30 days and 28% at 90 days. Malignancy as the indication for PEG was associated with increased mortality at 90 days (OR 4.41, 95% CI 2.20–8.88). Other factors significantly associated with increased mortality were older age, female sex, diabetes mellitus, heart failure, lower body mass index and higher C-reactive protein levels. Minor and major complications within 30 days occurred in 11% and 15% of the patients, respectively. Diabetes increased the risk of minor complications (OR 2.61, 95% CI 1.04-6.55), while those aged 75+ years were at an increased risk of major complications, compared to those younger than 65 years (OR 2.23, 95% CI 1.02-4.85).Conclusions: The increased risk of death among women and patients with malignancy indicate that these patients could benefit from earlier referral for PEG. Additionally, we found that age, diabetes, heart failure, C-reactive protein and body mass index all impact the risk of adverse outcomes.

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Section: Discussionsupporting

confidence: 72%

Mortality and complications after percutaneous endoscopic gastrostomy, a retrospective multicentre study

Stenberg¹,

Eriksson²,

Odensten

et al. 2022

Preprint

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“…Nonetheless, some studies have indicated that urea levels can be used to predict shortterm mortality rates in cardiac diseases (19). Moreover, Sbeit et al indicated that creatinine and some other parameters could predict short-term mortality after PEG (20). In the current study, although no differences were observed between the groups' creatinine values, urea was identified as an independent predictive factor for 30-day mortality after PEG placement.…”

Section: Discussioncontrasting

confidence: 42%

Predictive factors of complications and 30-day mortality in patients undergoing percutaneous endoscopic gastrostomy: the utility of C-reactive protein to albumin ratio

Düzenli¹,

Ketenci²,

Akyol³

et al. 2021

AGEB

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Background and study aims: Percutaneous endoscopic gastrostomy (PEG) is a procedure that provides long term enteral nutrition. To investigate the predictors of PEG-related complications and 30-day mortality rates and evaluate the indicators for deciding whether to recommend elective PEG insertions, we sought to determine the complications and early mortality rates of patients who underwent PEG. Patients and methods: We performed a retrospective analysis of consecutive adult patients who had undergone PEG for the first time between October 2016 and January 2019. The predictors of complications and 30-day mortality were analyzed with receiver operating characteristic (ROC) and logistic regression analysis. Results: This study included 309 patients. Patients were excluded from the study if they were < 18 years of age or there were missing data about them. Out of 253 patients, 33 (13%) had complications and 32 (12.6%) died within one month after PEG insertion. A higher C-reactive protein (CRP) to albumin ratio was the only independent factor predicting the complications (odds ratio (OR) : 3.17 ; 95% CI : 1.26-8.00 ; p = 0.014). The independent predictive factors for 30-day mortality after PEG placement included higher urea levels and higher CRP to albumin ratios (OR : 3.78 ; 95% CI : 1.41-10.17 ; p = 0.008) (OR : 6.67 ; 95% CI : 1.87- 23.75 ; p = 0.003). The only predictor for both complications and 30-day mortality was the CRP to albumin ratio. Conclusions: When appropriate, the PEG procedure can provide a safe and effective method for enteral feeding. The CRP to albumin ratio can be used to predict complications and early mortality after PEG insertion. Because PEG is elective, higher CRP to albumin ratios can be helpful in deciding to select patients for the procedure.

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“…In a recent study from Israel (n = 272) multivariate analysis identified older age, higher creatinine levels and elevated CRPto-albumin ratio as significant predictors of short-term mortality after PEG placement [89]. Finally, in two further recent large studies, from Italy and Sweden (n = 950 and n = 495, respectively), age and lower body mass index (BMI) were identified as risk factors for mortality [58,85] (Table 3s).…”

Section: Post-proceduralmentioning

confidence: 94%

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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Main recommendationsESGE recommends the “pull” technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer (“push”) technique for PEG placement in cases where the “pull” method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed “blindly” at the patient’s bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 – 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 – 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.

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Simple Bedside Predictors of Survival after Percutaneous Gastrostomy Tube Insertion

Cited by 8 publications

References 20 publications

Mortality and complications after percutaneous endoscopic gastrostomy, a retrospective multicentre study

Mortality and complications after percutaneous endoscopic gastrostomy, a retrospective multicentre study

Predictive factors of complications and 30-day mortality in patients undergoing percutaneous endoscopic gastrostomy: the utility of C-reactive protein to albumin ratio

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

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