Long-term survival in patients undergoing percutaneous endoscopic gastrostomy and jejunostomy

Percutaneous endoscopic gastrostomy (PEG) used to supply enteral nutrition has supplanted surgically placed feeding tubes in many institutions. These tubes are currently placed in: 1) patients with reversible disease with potential for recovery (stroke, Guillain-Barré syndrome); 2) patients with incurable disease with potential for extended survival (head and neck cancer, amyotrophic lateral sclerosis); or 3) patients who are terminal or seriously debilitated (head trauma, systemic malignancies). Few data are currently available regarding long-term survival, survival difference between various patient populations, and incidence of recovery of oral intake with subsequent PEG tube removal. In this study, records of 191 patients in whom PEG tubes were placed were retrospectively reviewed and information collected regarding underlying diseases (malignant vs nonmalignant), survival, and incidence of subsequent tube removal. Of the patients, 68 (36%) had cancer, and 123 (64%) had benign disease (usually stroke or other neurologic disorder). Survival curve analysis demonstrated that one-third of patients were dead within 60 days of PEG placement, and half were dead in the first 6 months. Total deaths were 115 (60%) at a median time of 164 days. No mortality was directly related to acute or subsequent PEG tube complications. Feeding tubes were removed in 41 patients (21%), 10 with cancer (5%), and 31 without (16%, p less than 0.05). These data on limited patient survival and low incidence of recovery of oral intake suggest that facilitation of hospital discharge into a less expensive home care or step-down facility is the most likely goal to be realized after PEG placement. Further, these results raise questions regarding the appropriateness of PEG placement in patients with anticipated early mortality or low likelihood of hospital discharge.