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Complications and outcome of percutaneous endoscopic gastrostomy in different patient groups
1Department of Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
Insights
Percutaneous endoscopic gastrostomy (PEG) is a useful feeding procedure, though wound infection is a common complication. Prophylactic antibiotics did not significantly reduce early wound infections in this study.
Area of Science:
- Gastroenterology
- Surgical Procedures
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a vital intervention for nutritional support in patients unable to feed orally.
- Complications and optimal practices surrounding PEG placement require ongoing evaluation.
Purpose of the Study:
- To assess PEG-related complications.
- To determine the efficacy of prophylactic antibiotics in preventing early wound infections.
- To evaluate patient outcomes across different diagnostic groups.
Main Methods:
- A retrospective analysis of 50 patients undergoing PEG between March 1991 and November 1993.
- Data collection included complications, mortality, and patient outcomes.
- Follow-up was completed in July 1994.
Main Results:
- Wound infection was the most frequent complication (13 cases).
- Prophylactic antibiotics showed no significant benefit in preventing early wound infections (2/13 vs. 6/37).
- Outcomes varied by group: high mortality in neurological disease and AIDS patients, full recovery in head injury patients.
Conclusions:
- PEG is a beneficial procedure for nutritional support across diverse patient populations.
- Wound infection is a manageable complication, and the routine use of prophylactic antibiotics is not clearly supported.
- Delayed PEG insertion may be associated with lower early mortality.
Abstract:
A retrospective study of percutaneous endoscopic gastrostomy (PEG) was performed to evaluate the complications of PEG and determine the role of prophylactic antibiotics in preventing early wound infection and to evaluate the outcome of patients in different groups (neurological disease, head injury, AIDS). Percutaneous endoscopic gastrostomy was performed on 50 patients between March 1991 and November 1993 and the survey was completed in July 1994. The average time to PEG placement post-cerebrovascular accident or head injury was 5 weeks. No deaths were attributable to the procedure. Four of 50 (8%) patients died in the first 30 days (early mortality). Wound infection (early eight, late five) was the most common complication: two of 13 patients receiving prophylactic antibiotics and six of 37 not receiving antibiotics had early wound infection. At completion of follow-up 19 of 26 patients with neurological disease had died (median survival = 370 days), three resumed oral feeding and four continued PEG feeding. All head injury patients (n = 6) were alive and had resumed oral feeding; five returned home. All AIDS patients (n = 7) died within 12 months (median survival = 138 days), although improved nutritional state was found after gastrostomy feeding. In conclusion, PEG placement is a useful procedure to assist feeding in multiple patient groups. Wound infection is a common but not life threatening complication. The need for prophylactic antibiotics to prevent early wound infection has not been proven. The 5 week delay in PEG insertion may contribute to lower early mortality. The 100% survival rate in head injury patients may reflect their young age and absence of underlying medical illness. In AIDS patients, improved nutritional state is not known to translate into better quality of life or prolonged survival.