Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients.
OBJECTIVE
Percutaneous endoscopic gastrostomy (PEG) is a widely used method for insertion of a gastrostomy tube in patients who are unable to eat but have a normally functioning gut. Complications have been described, especially in fragile, debilitated patients, and 30-day mortality rates of 4.1-26% have been reported. We assessed the outcome of PEG tube placement for inpatients and outpatients, based on morbidity, mortality, and long-term survival.


METHODS
We reviewed the medical records of all patients who underwent PEG at our institution between January 1, 1995 and December 31, 1996. Four groups of patients were compared: Group 1, patients from nursing homes; Group 2, hospitalized patients; Group 3, hospitalized patients matched to Group 2 for diseases, except mental disorder, and not treated with PEG; and Group 4, the general hospital population matched for age.


RESULTS
A total of 114 PEG tubes were inserted in 114 patients, 47 from Group 1, 67 from Group 2. Eighty-seven percent of patients in Group 1 underwent PEG because of dementia, versus 46% of Group 2 (p<0.001). The mortality rate was five times higher in Group 2 than in Group 3 (p<0.001). The 30-day mortality was seven times higher in Group 2 than in Group 1, twice that in Group 3, and five times higher than in Group 4 (p = 0.002 and p<0.001, respectively). When intention-to-treat analyses were applied to the data, 19/48 patients died (39.5%) in Group 1, and 60/83 (72.0%) died in Group 2, (p<0.001).


CONCLUSIONS
Patients hospitalized with acute illness are at high risk for serious adverse events after PEG insertion and this procedure should be avoided.
Abuksis
G
G
Department of Gastroenterology, Rabin Medical Center, Petach Tikva, Israel.
Mor
M
M
Segal
N
N
Shemesh
I
I
Plout
S
S
Sulkes
J
J
Fraser
G M
GM
Niv
Y
Y
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications; D015897:Comorbidity; D004724:Endoscopy; D004750:Enteral Nutrition / Q000401:mortality; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009735:Nursing Homes; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate