title: An assessment of open access referral for percutaneous endoscopic gastrostomy in a district general hospital.
abstract: OBJECTIVE
  To determine the indications, technical success and outcomes of open access percutaneous endoscopic gastrostomy (PEG) insertion in the district general hospital setting.
  
  
  METHODS
  This study was a retrospective audit of patients receiving PEG by the thread pull method from November 1998 to November 1999, followed by a prospective audit of patients receiving PEG from December 1999 to May 2000. Prophylactic antibiotics were not used. Patient data were collected using a computerized endoscopy unit record system. Clinical assessment was performed and case notes were reviewed. Whenever necessary, telephone follow-up of patients in the community was performed.
  
  
  METHODS
  Sixty-five consecutive, unselected patients underwent PEG and 64 were followed up for a total of 7799 patient days. Fifty-seven of 64 (89%) were in-patients. The median age of the patients was 74 years (range, 26-95 years).
  
  
  METHODS
  Indications, technical success, early complications and long-term outcomes of PEG.
  
  
  RESULTS
  Cerebrovascular disease was the most common indication for PEG (35/64 (55%)). Technical success was achieved in 62/64 (97%) patients. No serious complications from the procedure were reported: PEG site infection was rare (1/64). Pneumonia was uncommon (8/64 (12.5%)). There were eight (12.5%) deaths during the first week after PEG insertion and 18/64 (28%) during the first month. Mortality at 1 year was 36/64 (56%). Ten of 64 patients (16%) recovered to PEG removal; 18 (28%) continue to be fed via PEG.
  
  
  CONCLUSIONS
  This audit demonstrates that referral patterns, technical success and long-term outcome of open access referral for PEG in a district general hospital setting are consistent with published series from specialist and tertiary referral centres.
authors.affiliation: Kent & Sussex Hospital, Tunbridge Wells TN4 8AT, UK. mark.fox@DIM.usz.ch
authors.forename: Mark R
authors.initials: MR
authors.lastname: Fox
authors.forename: Adam W
authors.initials: AW
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D005773:Gastroscopy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D005774:Gastrostomy / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy; D014600:Utilization Review