Resumption of oral intake following percutaneous endoscopic gastrostomy.
OBJECTIVE
Percutaneous endoscopic gastrostomy (PEG) provides enteral nutrition to patients who cannot swallow. Few studies have prospectively evaluated its long-term outcomes or eventual resumption of oral intake.


METHODS
Consecutive PEG patients were prospectively recruited from a tertiary hospital over 12 months and followed until all had met the primary endpoints of death or resumption of oral diet with PEG extubation. Data was collected by standardised periodic phone interview.


RESULTS
Forty patients (24 males, median age 74 years) were followed for up to 8.4 years (median 5.3 months, interquartile range [IQR] 13.6 months). The end-of-study mortality rate was 70% (median 6.8 months, IQR 19.9 months) and the only predictor of mortality was head injury as the indication for PEG (Cox regression HR 5.90, 95% CI: 1.2-28.4). At two years following PEG, 30% of patients had resumed oral intake (median 2.9 months, IQR 7.2 months) and 19% remained on PEG-feeding. Predictors of resumption of oral intake were the ability to tolerate some oral intake at 3 months (HR: 248.5, 95% CI: 8.7-7065.3) and 6 months (HR: 6.3, 95% CI: 1.03-38.9) but not at 12 months. Cumulative survival was highest for ear nose and throat (ENT) tumour and worst for acute head injury (log rank P = 0.048).


CONCLUSIONS
Half of all PEG patients remained alive at 2 years using PEG or have resumed full oral intake. A supervised trial of oral intake at 3 or 6 months may help predict eventual resumption of per oral diet.
Paramsothy
Sudarshan
S
Gastroenterology and Liver Services, Sydney South West Area Health Service, Concord Hospital, Concord, Sydney, New South Wales, Australia.
Papadopoulos
George
G
Mollison
Lindsay C
LC
Leong
Rupert W L
RW
D000368:Aged; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D016145:Endoscopy, Digestive System / Q000401:mortality; D004750:Enteral Nutrition / Q000379:methods*; D005215:Fasting; D005260:Female; D005774:Gastrostomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate