An assessment of open access referral for percutaneous endoscopic gastrostomy in a district general hospital

To determine the indications, technical success and outcomes of open access percutaneous endoscopic gastrostomy (PEG) insertion in the district general hospital setting.

This study was a retrospective audit of patients receiving PEG by the thread pull method from November 1998 to November 1999, followed by a prospective audit of patients receiving PEG from December 1999 to May 2000. Prophylactic antibiotics were not used. Patient data were collected using a computerized endoscopy unit record system. Clinical assessment was performed and case notes were reviewed. Whenever necessary, telephone follow-up of patients in the community was performed.

Sixty-five consecutive, unselected patients underwent PEG and 64 were followed up for a total of 7799 patient days. Fifty-seven of 64 (89%) were in-patients. The median age of the patients was 74 years (range, 26-95 years).

Indications, technical success, early complications and long-term outcomes of PEG.

Cerebrovascular disease was the most common indication for PEG (35/64 (55%)). Technical success was achieved in 62/64 (97%) patients. No serious complications from the procedure were reported: PEG site infection was rare (1/64). Pneumonia was uncommon (8/64 (12.5%)). There were eight (12.5%) deaths during the first week after PEG insertion and 18/64 (28%) during the first month. Mortality at 1 year was 36/64 (56%). Ten of 64 patients (16%) recovered to PEG removal; 18 (28%) continue to be fed via PEG.

This audit demonstrates that referral patterns, technical success and long-term outcome of open access referral for PEG in a district general hospital setting are consistent with published series from specialist and tertiary referral centres.