Evaluating The Factors Affecting Mortality and Survival of the Patients Who Underwent Percutaneous Endoscopic Gastrostomy; The Short-term and Long-term Results

Yıl 2024, Cilt: 7 Sayı: 3, 153 - 157, 30.09.2024

Betül Keskinkılıç Yağız , Metin Yalaza

https://doi.org/10.36516/jocass.1516182

Öz

Summary
Aim
Percutaneous endoscopic gastrostomy (PEG) is a common minimally invasive technique performed in patients with oral feeding problems. The aim of the current study is to evaluate the associated factors that have an impact on the short- and long-term survival and mortality in these patients who received PEG tube placement.
Materials and Methods
The patients who underwent PEG placement between June 2020 and June 2023 are enrolled in the study. Mortality data was extracted from the National Death Registry database. Data regarding the demographics, indications of PEG, co-morbidities, length of hospital stay prior to PEG procedure, the need for mechanical ventilator support, body-mass index, serum levels of hemoglobin, leukocyte, albumin, and c-reactive protein are extracted retrospectively. Kaplan Meier and Cox regression analyses were used to evaluate the factors affecting survival.
Results
A total of 137 patients are enrolled in the study (71 female and 66 male). One-month mortality was 16.7% and overall mortality during a follow-up of 38 months was 51%. Survival was significantly higher in patients with motor neuron diseases than the patients with Alzheimer’s (p=0.036). Length of hospital stay before PEG placement and hemoglobin levels were found to have a significant impact on survival in Cox regression analysis (p=0.000, p=0,009).
Conclusion
Length of hospital stay before PEGplacement, need for mechanical ventilator support and hemoglobin levels were found significantly associated with survival. Higher mortality in Alzheimer's patients may indicate that indications of PEG should be re-evaluated in these patients.

Anahtar Kelimeler

Percutaneous endoscopic gastrostomy, survival, mortality

Kaynakça

• 1.Pennington C. To PEG or not to PEG. Clin Med (Lond). 2002;2(3):250-5. https://doi.org/10.7861/clinmedicine.2-3-250
• 2.Gauderer MW, Ponsky JL, Izant RJ, Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15(6):872-5. https://doi.org/10.1016/S0022-3468(80)80296-X
• 3.Galletti R, Finocchiaro E, Repici A, Saracco G, Zanardi M. Comparison of complication rates between endoscopic and fluoroscopic percutaneous gastrostomies. Nutrition. 2001;17(11-12):967-8. https://doi.org/10.1016/S0899-9007(01)00607-4
• 4.Kurien M, McAlindon ME, Westaby D, Sanders DS. Percutaneous endoscopic gastrostomy (PEG) feeding. Bmj. 2010;340:c2414. https://doi.org/10.1136/bmj.c2414
• 5.Welbank T, Kurien M. To PEG or not to PEG that is the question. Proc Nutr Soc. 2021;80(1):1-8. https://doi.org/10.1017/S002966512000703X
• 6.Mitchell SL, Lawson FM. Decision-making for long-term tube-feeding in cognitively impaired elderly people. Cmaj. 1999;160(12):1705-9.
• 7. Carey TS, Hanson L, Garrett JM, Lewis C, Phifer N, Cox CE, et al. Expectations and outcomes of gastric feeding tubes. Am J Med. 2006;119(6):527.e511-26. https://doi.org/10.1016/j.amjmed.2005.11.021
• 8.Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. Jama. 1999;282(14):1365-170. https://doi.org/10.1001/jama.282.14.1365
• 9.Gillick MR. Rethinking the role of tube feeding in patients with advanced dementia. N Engl J Med. 2000;342(3):206-10. https://doi.org/10.1056/NEJM200001203420312
• 10.Nair S, Hertan H, Pitchumoni CS. Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia. Am J Gastroenterol. 2000;95(1):133-6. https://doi.org/10.1111/j.1572-0241.2000.01673.x
• 11.DeLegge MH. Enteral Access and Associated Complications. Gastroenterol Clin North Am. 2018;47(1):23-37. https://doi.org/10.1016/j.gtc.2017.09.003
• 12.Virnig DJ, Frech EJ, Delegge MH, Fang JC. Direct percutaneous endoscopic jejunostomy: a case series in pediatric patients. Gastrointest Endosc. 2008;67(6):984-7. https://doi.org/10.1016/j.gie.2007.11.008
• 13.Maple JT, Petersen BT, Baron TH, Gostout CJ, Wong Kee Song LM, Buttar NS. Direct percutaneous endoscopic jejunostomy: outcomes in 307 consecutive attempts. Am J Gastroenterol. 2005;100(12):2681-8. https://doi.org/10.1111/j.1572-0241.2005.00334.x
• 14.Gülsoy KY, Çelik F, Orhan S. Percutaneous endoscopic gastrostomy results in a secondary state hospital. Eskisehir Medical Journal. 2023;4(1):6-10.
• 15.Arvanitakis M, Gkolfakis P, Despott EJ, Balllarin A, Beyna T, Boeykens K, et al. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(1):81-92. https://doi.org/10.1055/a-1303-7449
• 16.Kamran U, Lee PC, Coupland B, Abbasi A, Steed H, Ispoglou S, et al. Improving 30-day mortality after PEG tube placement in England from 2007 to 2019: a retrospective national cohort analysis of 87,862 patients. Gastrointest Endosc. 2022;96(6):943-953.e911. https://doi.org/10.1016/j.gie.2022.06.031
• 17.Komiya K, Usagawa Y, Kadota JI, Ikegami N. Decreasing Use of Percutaneous Endoscopic Gastrostomy Tube Feeding in Japan. J Am Geriatr Soc. 2018;66(7):1388-91. https://doi.org/10.1111/jgs.15386
• 18.Dwyer KM, Watts DD, Thurber JS, Benoit RS, Fakhry SM. Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients. J Trauma. 2002;52(1):26-32. https://doi.org/10.1097/00005373-200201000-00007
• 19.Goldberg LS, Altman KW. The role of gastrostomy tube placement in advanced dementia with dysphagia: a critical review. Clin Interv Aging. 2014;9:1733-9. https://doi.org/10.2147/CIA.S53153
• 20.Albayrak F, KisaoĞLu A, Albayrak Y, Er S, Temiz A, Aslan OB. Perkütan endoskopik gastrostomi: endikasyon ve komplikasyonlar. Akademik Gastroenteroloji Dergisi. 2015;14(3):113-116.
• 21.Özer Etik D, Suna N, Öcal S, Selçuk H. Percutaneous endoscopic gastrostomy in older patient population. Endoscopy Gastrointestinal. 2018;26:6-11. https://doi.org/10.17940/endoskopi.434900
• 22.Limpias Kamiya KJL, Hosoe N, Takabayashi K, Hayashi Y, Fukuhara S, Mutaguchi M, et al. Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy. JGH Open. 2021;5(5):590-8. https://doi.org/10.1002/jgh3.12538
• 23.Kawata N, Kakushima N, Tanaka M, Sawai H, Imai K, Hagiwara T, et al. Percutaneous endoscopic gastrostomy for decompression of malignant bowel obstruction. Dig Endosc. 2014;26(2):208-13. https://doi.org/10.1111/den.12139
• 24.Stenberg K, Eriksson A, Odensten C, Darehed D. Mortality and complications after percutaneous endoscopic gastrostomy: a retrospective multicentre study. BMC Gastroenterol. 2022;22(1):361. https://doi.org/10.1186/s12876-022-02429-0
• 25.de Souza e Mello GF, Lukashok HP, Meine GC, Small IA, de Carvolho LRT, Guimarapes DP, et al. Outpatient percutaneous endoscopic gastrostomy in selected head and neck cancer patients. Surg Endosc. 2009;23(7):1487-93. https://doi.org/10.1007/s00464-009-0381-y
• 26.Erdil A, Saka M, Ates Y, Tüzün A, Bağcı S, Uygun A, et al. Enteral nutrition via percutaneous endoscopic gastrostomy and nutritional status of patients: five-year prospective study. J Gastroenterol Hepatol. 2005;20(7):1002-7. https://doi.org/10.1111/j.1440-1746.2005.03892.x
• 27.Pearce CB, Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J. 2002;78(918):198-204. https://doi.org/10.1136/pmj.78.918.198
• 28.Bochatay L, Bastid C, Robert J, Giostra E, Spahr L, Bichard P, et al. Underlying disease for percutaneous endoscopic gastrostomy tube placement predicts short- and long-term mortality. Acta Gastroenterol Belg. 2022;85(1):29-33. https://doi.org/10.51821/85.1.7953
• 29.Chong VH, Vu C. Percutaneous endoscopic gastrostomy outcomes: can patient profiles predict mortality and weaning? Singapore Med J. 2006;47(5):383-7.
• 30.Pih GY, Na HK, Ahn JY, Jung KW, Kim DH, Lee JH, et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion. BMC Gastroenterol. 2018;18(1):101. https://doi.org/10.1186/s12876-018-0825-8