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Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988
R H Skelly1, R M Kupfer, M E Metcalfe
1Southern Derbyshire Acute Hospitals NHS Trust, UK.
Clinical Nutrition (Edinburgh, Scotland)
|October 17, 2002
Summary
Percutaneous endoscopic gastrostomy (PEG) 30-day mortality has increased to 19% from 8% due to sicker patients, primarily elderly individuals with cerebrovascular disease. Age and functional status are key factors influencing early death risk after PEG procedures.
Area of Science:
- Gastroenterology
- Geriatrics
- Clinical Outcomes
Background:
- Previous percutaneous endoscopic gastrostomy (PEG) 30-day mortality was 8% (1988-1992).
- Concerns arose regarding potentially increasing mortality rates.
- A survey was conducted to compare current practice with 1988-1992 data.
Purpose of the Study:
- Assess current percutaneous endoscopic gastrostomy (PEG) practice.
- Evaluate case mix and patient outcomes.
- Identify risk factors for early mortality and review guidelines.
Main Methods:
- Prospective evaluation of 78 consecutive adult patients referred for PEG over 7 months.
- Collected baseline characteristics: age, functional status (Barthel Index).
- Monitored outcomes at 30 and 180 days.
Main Results:
- 74 patients completed the study; median age 69 years, 55% male.
- Major diagnoses shifted: cerebrovascular disease increased (42% vs 33%), motor neurone disease decreased (4% vs 27%).
- 30-day mortality rose to 19% (vs 8%), with significant risk factors including age >75, Barthel Index <1, and Glasgow Coma Scale ≤10.
Conclusions:
- 30-day mortality following PEG significantly increased from 8% to 19%.
- This reflects a shift in referral patterns towards more elderly patients with cerebrovascular disease.
- Age and functional status are critical considerations for advising on PEG feeding.
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