Improving All-Cause Inpatient Mortality After Percutaneous Endoscopic Gastrostomy

Stein, Daniel J.; Moore, Matthew; Hoffman, Gila; Feuerstein, Joseph D.

doi:10.1007/s10620-020-06396-y

Cited by 9 publications

(9 citation statements)

References 14 publications

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“…A large retrospective cohort analysis of all adult inpatients undergoing PEG placement in the United States found that all-cause in-hospital mortality rates of PEG dropped from 10.8% to 6.6% over a 10-year time period (P < 0.001). 20 However, the incidence of complications remained the same over the 10-year time period (4.4% vs 5.1%, P = 0.2). Moreover, the total number of cases decreased from 174,228 to 155,550.…”

Section: Discussionmentioning

confidence: 83%

Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy

Li¹,

Wang²,

Wang³

et al. 2022

JMDH

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Objective To compare indications, success rates and complications of pull [P] and introducer [I] techniques for percutaneous endoscopic gastrostomy (PEG). Methods In this retrospective study, inpatients who underwent primary PEG tube insertion between January 2015 and February 2020 at the Endoscopy Center of the First Affiliated Hospital of Fujian Medical University were included. Results A total of 103 inpatients were included in this study (P group, n = 67; I group, n = 36). The rates of tube replacement within first six months in the P and I groups were 1.5% and 11.1%, respectively (P = 0.049). The most common primary indication of PEG was malignancy. The proportion of patients with esophageal cancer was significantly lower in the P group (24.4% vs 54.2%, P = 0.015). No significant difference was found in the overall, major, or minor complications between the two groups. In patients with esophageal stenosis, the pull method was a risk factor for complications (P = 0.03; odds ratio [OR] = 12, 95% confidence interval [CI]: 1.164–123.684). Logistic regression analysis showed that the risk factors for major and minor complications were the admission-to-gastrostomy interval (OR = 1.078, 95% CI: 1.016–1.145, P = 0.014) and lack of antibiotic use (OR = 4.735, 95% CI: 1.247–17.979, P = 0.022), respectively. Conclusion Both PEG techniques have high clinical success rates. The introducer technique is more suitable for patients with esophageal stricture, which has lower minor complications, but higher rate of tube replacement compared to the pull technique. Use of antibiotics may reduce minor complications following PEG. Early PEG insertion may help to reduce post-PEG major complications.

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Section: Discussionmentioning

confidence: 83%

Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy

Li¹,

Wang²,

Wang³

et al. 2022

JMDH

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“…In addition, our findings showed that men had a higher number of gastrostomies and a higher implementation rate of swallowing function assessment (in those aged ≥80 years). This finding might be explained by the most frequent underlying diseases for PEG tube placement being stroke 12,19 and the higher prevalence of stroke in men. 20 We confirmed the decreasing trend of gastrostomies from 2014 to 2016 with the total number of implementations of the procedures in the national claims database, which was consistent with the findings from previous studies with representative samples.…”

Section: Discussionmentioning

confidence: 98%

“…11 A study using the national inpatient sample also showed a decrease in the number of PEG tube placements from 2006 to 2016, with a decrease in mortality with stable complication rates, suggesting improved patient selection. 12 In contrast, the incidence of PEG markedly increased from 1997 to 2010 in Taiwan, with increases in the severity of accompanying diseases, medical costs and post-PEG mortality rates. 13 In Japan, the number of PEG tube placements increased in the early 2000s, and studies using data sampled nationally reported that the number of gastrostomies peaked in 2010.…”

Section: Introductionmentioning

confidence: 99%

“…In the US, the proportion of those with PEG tubes decreased among nursing home residents with advanced dementia and recent eating dependency from 2000 to 2014 11 . A study using the national inpatient sample also showed a decrease in the number of PEG tube placements from 2006 to 2016, with a decrease in mortality with stable complication rates, suggesting improved patient selection 12 . In contrast, the incidence of PEG markedly increased from 1997 to 2010 in Taiwan, with increases in the severity of accompanying diseases, medical costs and post‐PEG mortality rates 13…”

Section: Introductionmentioning

confidence: 99%

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National trends in gastrostomy in older adults between 2014 and 2019 in Japan

Hattori

Hamada

Ishizaki

et al. 2022

Geriatrics Gerontology Int

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Aim Previous studies have shown temporal trends in the number of gastrostomies until 2016, but the recent trend is yet to be analyzed. This study aimed to evaluate temporal trends in gastrostomy (mostly percutaneous endoscopic gastrostomy) in older adults in Japan in more recent years. Methods We extracted data on the numbers of gastrostomies and swallowing function assessment prior to gastrostomy, using the national aggregated open data (NDB Open Data) from 2014 to 2019. Results Adults in their 80s accounted for the largest portion of gastrostomy during the study period. A decreasing trend in the total number of gastrostomy was observed in older adults from 2014 to 2016, but became almost stable thereafter (57 103 in 2014, 47 228 in 2016, and 47 944 in 2019). The age group‐stratified numbers of gastrostomy per 100 000 individuals decreased by −33.9% (≥90 years group) to −6.1% (65–69 years group) from 2014 to 2019. The implementation rate of the swallowing function assessment remained relatively low, despite a slight increase (21.4% in 2015 to 23.7% in 2019). Conclusion We showed that the total number of gastrostomies remained almost stable after 2016 despite population aging. We considered that the avoidance of gastrostomy in frail or disabled older adults might explain the decrease, particularly for those aged over 80 years. Our findings would regain attention to appropriate decision‐making for gastrostomy. Geriatr Gerontol Int 2022; 22: 648–652.

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“…The ICU-specific nutrition guidelines have suggested early nutrition (EN) within 24-48 hours following the intervention [10]. Furthermore, the influence of hypoalbuminemia, serum C-reactive protein levels, metastatic cancer, and other comorbid diseases on mortality after PEG is well-documented [11]. Both albumin levels and hemogram values of the patients undergoing PEG in the ICU were significantly lower than in the other patients; their CRP levels were significantly higher; and the 30-day mortality was also higher in these ICU patients, as expected.…”

Section: Discussionmentioning

confidence: 99%

Covid-19 Enfeksiyonunda Perkütan Endoskopik Gastrostomi Zamanlaması: Endoskopik Cerrahi Ünite Deneyimi

Fırat

Aziret

Mantoğlu

et al. 2021

Archives of Clinical and Experimental Medicine

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Aim: The COVID-19 pandemic has negatively affected the whole world and health systems. Although the literature includes recommendations regarding the timing of Percutaneous endoscopic gastrostomy (PEG) in COVID-19 patients, there are no significant clinical studies yet. Therefore, we aim to contribute to the literature by sharing our data on this subject. Materials and Methods: Patients who underwent PEG between March 2020 and March 2021 were retrospectively evaluated in our clinic. The patients were compared statically in terms of age, gender, medical indications, comorbid diseases, hospitalization in the intensive care unit (ICU), blood tests, and post-intervention complications. PEG was inserted routinely in PCR-negative patients. Patients who underwent PEG were compared as outpatients and inpatients in the ICU. Moreover, patients who underwent PEG while hospitalized in the ICU were divided into two groups according to the presence of COVID-19 infection; patients noninfected with COVID-19 (group 1) and COVID-19 infected patients (group 2). Results: PEG was performed in 66 patients during the COVID-19 pandemic. These patients predominantly consisted of those with SVH, Alzheimer's, or traumatic brain injury. In the present study, thirty-two (%48.5) patients were female with a mean age of 69.4±17.6, and forty-seven patients underwent PEG in the ICU. Furthermore, eleven of these patients were COVID-19, infected patient group (group-2). There was no statistical difference in blood albumin levels, CRP, hemogram results, and 30-day mortality results between group 1 and group 2 (P>0.05). Conclusion: PEG is a minimally invasive intervention that is commonly used for enteral feeding. The timing of the procedure is crucial for inpatients with COVID-19. Although the most appropriate timing is the 30th day after the COVID-19 infection process, we think that PEG may insert on the 10th day in eligible patients.

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Improving All-Cause Inpatient Mortality After Percutaneous Endoscopic Gastrostomy

Cited by 9 publications

References 14 publications

Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy

Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy

National trends in gastrostomy in older adults between 2014 and 2019 in Japan

Covid-19 Enfeksiyonunda Perkütan Endoskopik Gastrostomi Zamanlaması: Endoskopik Cerrahi Ünite Deneyimi

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