title: National survey evaluating service provision for percutaneous endoscopic gastrostomy within the UK.
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomy (PEG) feeding has a significant morbidity and mortality associated with the procedure. Patient selection, procedural volume, timing of insertion and aftercare may have a direct bearing on mortality. We aimed to establish whether variation in PEG practice exists within the UK.
  
  
  METHODS
  The British Society of Gastroenterology (BSG) approached all NHS hospitals providing an endoscopy service (n = 260). A custom designed web-based questionnaire was circulated.
  
  
  RESULTS
  The response rate was 83% (n = 215); 57% were Joint Advisory Group (JAG) accredited; 33% (70/215) of hospitals inserted more than 75 PEGs a year (4 hospitals inserting >150). Stroke and neurodegenerative conditions were the main indications for PEG insertion. However, 36% (77/215) of hospitals inserted PEGs for dementia. PEG insertion timings varied: 33% (72/215) had a strict policy of waiting more than 2 weeks from referral to insertion, 14% (30/215) performed immediately and 34% (74/215) determined the time delay depending on the underlying condition. Local guidelines for PEG insertion existed in 87% (186/215) of hospitals and 78% (168/215) had access to radiologically inserted gastrostomies. Prophylactic antibiotics were used in 93% (201/215) of hospitals. Only 64% (137/215) had a dedicated PEG aftercare service. This was significantly lower in non-JAG accredited units (p = 0.008).
  
  
  CONCLUSIONS
  This National BSG survey demonstrates variations in practice particularly with regards to PEG insertion in patients with dementia, the timing of PEG insertion and PEG aftercare. These variations in practice may be important factors accounting for the significant morbidity and mortality associated with this procedure.
authors.affiliation: Endoscopy & Small Bowel/Nutrition sections of the British Society of Gastroenterology, London, UK. matthew.kurien@sth.nhs.uk
authors.forename: Matthew
authors.initials: M
authors.lastname: Kurien
authors.forename: David
authors.initials: D
authors.lastname: Westaby
authors.forename: Chris
authors.initials: C
authors.lastname: Romaya
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D003704:Dementia / Q000628:therapy; D004750:Enteral Nutrition / Q000592:standards* / Q000706:statistics & numerical data; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006779:Hospitals, Public / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom