Acutely Ill Patients Have Poor Outcome Following Peg Placement

Nutrition Research Newsletter, March, 2000

Percutaneous endoscopic gastrostomy (PEG) is a common means of providing nutrition to those with eating impairments but functional gastrointestinal tracts. Frequent recipients include individuals with head and neck cancers, those with dysphagia due to stroke, and individuals impaired as a result of dementia. This procedure involves the endoscopic placement of a gastrostomy tube into the individual with the impairment. In the United States, the number of individuals receiving PEGs doubled between 1988 and 1995. The use of PEGs is associated with several severe complications including pneumonia due to aspiration of the gastric contents, dislodgment of the tube, obstruction of the lumen, anesthetic adverse events during the tube placement, esophageal perforation, hemorrhage, and wound infection. Often, the individuals who receive PEGs have short life expectancies due to the nature of their disease course. Thirty-day mortality rates following PEG placements have been reported as high as 4.1-26%. Because of the potential of multiple complications, questions have arisen regarding the efficacy of the placement procedure.

To further investigate this issue, researchers assessed the outcome of PEG tube placement in both inpatients and outpatients with regard to morbidity, mortality, and long-term survival. A retrospective study of patients receiving PEGs was compared to a matched control of hospitalized patients who did not undergo PEG. Medical records of all patients receiving PEGs over a two-year period at the Rabin Medical Center in Israel were reviewed. Four different groups of patients were compared. Group 1 comprised patients from nursing homes, group 2 comprised hospitalized patients, group 3 comprised hospitalized patients matched to group 2 for disease who were not treated with PEG, and group 4 consisted of the general hospital population.

During this two-year period, a total of 114 PEG tubes were placed, 47 in group 1 and 67 from group 2. The mortality rate was five times higher in group 2 than in group 3. The mortality rate of group 2 was seven times that of group 1, twice as high as group 3, and five times higher than group 4.

From these results, it can be concluded that patients hospitalized with acute illnesses have poor outcome associated with PEG tube placement. The investigators feel that PEG insertion should be avoided in acutely ill, hospitalized patients.

G. Abuksis, M. Mor, N. Segal, et al., Percutaneous Endoscopic Gastrostomy: High Mortality Rates in Hospitalized Patients, Am J Gastroenterol 95: 128-132 (January 2000) [Correspondence: Gerald M. Fraser, MD, FRCP, Dept. of Gastroenterology, Beilinson Campus, Rabin Medical Center, Petach Tikva 49100, Israel.]