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Published on: April 17, 2020
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.
Insights
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.
Introduction:
Percutaneous endoscopic gastrostomy (PEG) is a common procedure performed world-wide on patients with different comorbidities, with many indications and overall low morbidity. However, studies showed an elevated early mortality in patients undergoing PEG placement. In this systematic review, we review the factors associated with early mortality after PEG.
Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The methodological index for nonrandomized studies (MINORS) score system was used to perform qualitative assessment of all included studies. Recommendations were summarized for predefined key items.
Results:
The search found 283 articles. A refined total of 21 studies were included; 20 studies cohort studies and 1 case-control study. For the cohort studies, MINORS score ranged from 7 to 12 out of 16. The single case-control study scored 17 out of 24. The number of study patients ranged from 272 to 181,196. Thirty-day mortality rate varied from 2.4% to 23.5%. Albumin, age, body mass index, C-reactive protein, diabetes mellitus, and dementia were the most frequently associated factors to early mortality in patients undergoing PEG placement. Five studies reported procedure related deaths. Infection was the most commonly reported complication of PEG placement.
Conclusions:
PEG tube insertion is a fast, safe and effective procedure, but is not free of complications and can have a high early mortality rate as demonstrated in this review. Patient selection should be a key factor and the identification of factors associated with early mortality is important in the elaboration of a protocol to benefit patients.
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