ORIGINAL ARTICLE   

Minerva Gastroenterologica e Dietologica 2019 March;65(1):20-9

DOI: 10.23736/S1121-421X.18.02535-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Percutaneous endoscopic gastrostomy for enteral nutrition: a 5-year clinical experience with 324 patients

Ezekiel W. TOH YOON ¹ ✉, Kaori YONEDA ², Kazuki NISHIHARA ¹

¹ Department of Gastroenterology and Hepatology, Hiroshima Kyoritsu Hospital, Hiroshima, Japan; ² Endoscopy Center, Hiroshima Kyoritsu Hospital, Hiroshima, Japan

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is considered the route of choice for long-term enteral nutrition. In this study, we evaluated the short term outcomes of PEG and aimed to identify the risk factors for in-hospital mortality as well as adverse events such as aspiration pneumonia.
METHODS: Three hundred and twenty-four patients who received PEG for enteral nutrition between January 2007 and December 2011 were included in this study. Data regarding baseline characteristics, preoperative biomarkers and clinical outcomes were collected and analyzed.
RESULTS: The average patient age was 82.3±10.9 (SD) years old. 149 patients (46%) were men and 199 patients (61%) had stroke as a comorbidity. Postoperatively, feeding-related aspiration pneumonia was observed in 72 patients (22%), diarrhea in 40 patients (12%) and peristomal infection in 34 patients (11%). The average postoperative length of stay was 34.6 days. 51 patients (16%) died before discharge, 22 (6.8%) of them within 30 days after PEG. Two deaths (0.6%) were considered procedure-related (bleeding). Multivariate analysis revealed the male gender, lower serum albumin levels and higher blood urea nitrogen (BUN) levels as significant prognostic factors for in-hospital mortality. Higher C-reactive protein levels and BUN levels were found to be independently associated with the occurrence of postoperative aspiration pneumonia.
CONCLUSIONS: Our experience reconfirmed PEG as a minimally invasive and safe procedure for long-term enteral nutrition in patients with impaired oral intake. However, significant prognostic factors should be taken into account during the preoperative evaluation of patients. Deferral of procedure or specialized postoperative care may be indicated in high risk patients.

KEY WORDS: Gastrostomy - Enteral nutrition - Endoscopy