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Published on: April 17, 2020
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Factors Associated with Mortality after Percutaneous Endoscopic Gastrostomy
Diego Laurentino Lima1, Luiz Eduardo Correia Miranda2, Raquel Nogueira Cordeiro Laurentino Lima3
1Department of Surgery, Montefiore Medical Center, New York, NY.
Summary
This systematic review identifies factors linked to early mortality after percutaneous endoscopic gastrostomy (PEG) procedures. Key factors include low albumin, advanced age, and comorbidities like diabetes, informing better patient selection for PEG placement.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Surgical Outcomes
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a widely performed procedure with generally low morbidity.
- However, evidence suggests a concerning elevated early mortality rate associated with PEG placement.
- This systematic review aims to identify factors contributing to this early mortality.
Approach:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Qualitative assessment of 21 included studies (20 cohort, 1 case-control) using the Methodological Index for Non-randomized Studies (MINORS) score.
- Analysis of patient demographics, comorbidities, and procedural outcomes from studies involving over 180,000 patients.
Key Points:
- Early mortality rates following PEG placement varied significantly across studies, ranging from 2.4% to 23.5%.
- Frequently associated factors with early mortality included low albumin levels, advanced age, higher body mass index, elevated C-reactive protein, diabetes mellitus, and dementia.
- Infection was the most commonly reported complication, and procedure-related deaths were noted in five studies.
Conclusions:
- While PEG insertion is generally safe and effective, it carries a risk of significant early mortality.
- Careful patient selection is crucial, and understanding factors associated with early mortality is vital for developing improved patient management protocols.
- Identifying high-risk patients can help optimize outcomes and reduce mortality post-PEG placement.
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