Assessment by a multidisciplinary clinical nutrition team before percutaneous endoscopic gastrostomy placement reduces early postprocedure mortality.
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.
Tanswell
I
I
Department of Gastroenterology, Staffordshire General Hospital, Stafford, United Kingdom. ian.tanswell@hhtr.nhs.uk
Barrett
D
D
Emm
C
C
Lycett
W
W
Charles
C
C
Evans
K
K
Hearing
S D
SD
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