title: Assessment by a multidisciplinary clinical nutrition team before percutaneous endoscopic gastrostomy placement reduces early postprocedure mortality.
abstract: BACKGROUND
  The purpose of this study was to determine whether preassessment by a multidisciplinary nutrition team before percutaneous endoscopic gastrostomy (PEG) placement can reduce postprocedure mortality. This was a prospective single-center audit.
  
  
  METHODS
  Patients who had been referred to the Gastroenterology Department for consideration of PEG placement between 1995 and 2004 were included. In the index year, 2003-2004, where a formal nutrition team assessment was commenced, 79 patients were enrolled into our study group on a consecutive basis. These patients were subdivided into 3 groups; group A, PEG placed (51 patients); group B, PEG not placed due to severe comorbidity (19 patients); and group C, PEG not placed as deemed unnecessary (9 patients). Comparison was made with previous years where no formal preassessment had occurred. At Staffordshire General Hospital, a comparison of mortality post-PEG placement was made between the index group and previous years. Secondary measures included complication rates and frequency of biochemical monitoring.
  
  
  RESULTS
  One week post-PEG mortality fell from 10%-20% in previous years to 0% in the index year (p < .02). This improved survival extended to 3 months postprocedure (p < .016). Three patients (6%) had biochemical evidence of refeeding syndrome postplacement. Biochemical monitoring was inadequate, with only 27/51 (53%) patients being completely monitored. No complications pertaining to the endoscopy were reported.
  
  
  CONCLUSIONS
  This study demonstrates that early post-PEG mortality can be reduced by preassessment of patients by a multidisciplinary nutrition team and is evidence supporting the recommendations of the National Confidential Enquiry into Patient Outcome and Death report.
authors.affiliation: Department of Gastroenterology, Staffordshire General Hospital, Stafford, United Kingdom. ian.tanswell@hhtr.nhs.uk
authors.forename: I
authors.initials: I
authors.lastname: Tanswell
authors.forename: D
authors.initials: D
authors.lastname: Barrett
authors.forename: C
authors.initials: C
authors.lastname: Emm
authors.forename: W
authors.initials: W
authors.lastname: Lycett
authors.forename: C
authors.initials: C
authors.lastname: Charles
authors.forename: K
authors.initials: K
authors.lastname: Evans
authors.forename: S D
authors.initials: SD
authors.lastname: Hearing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000592:standards; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011787:Quality of Health Care; D016019:Survival Analysis; D013997:Time Factors