Original Articles
A prospective evaluation of outcome in patients referred for PEG placement,☆☆

Presented in part as a poster at Digestive Disease Week, May 16-19, 1999, Orlando, Florida.
https://doi.org/10.1067/mge.2002.122577Get rights and content

Abstract

Background: PEG feeding is not recommended for short-term use because the 30-day mortality after PEG placement is substantial. The primary aim of this study was to prospectively identify factors predictive of survival in patients referred for PEG placement. Methods: All patients for whom gastroenterology consultation was sought for feeding PEG placement were prospectively studied. Demographic data, Charlson comorbidity index, and functional status were recorded at entry. After PEG placement, patients were followed for up to 12 months. Results: Of the 67 patients for whom consultation was requested, 58 were eligible for the study and 50 underwent PEG placement. The 7-day and 30-day mortality rates in the PEG placement group were 4% and 20%, respectively. In multivariate analysis, only the Charlson index ≥4 was associated with decreased survival time (relative hazard = 2.9: 95% CI [1.20, 7.21], p = 0.019). Median survival in patients with Charlson comorbidity index ≥4 was significantly shorter than that in patients with Charlson index <4 (p = 0.013). Conclusions: A Charlson comorbidity index ≥4 was significantly associated with shorter patient survival after initial consultation. Careful consideration of predictive factors of survival may improve patient selection for feeding PEG placement. (Gastrointest Endosc 2002;55:500-6.)

Section snippets

Patients and methods

All adult patients for whom gastroenterology consultation was sought for feeding PEG placement from October 1997 to December 1998 at our institution, an urban academic medical center, were eligible for the study. PEG placement was requested by the patients' primary physicians by means of the gastroenterology consultation service. Those patients in whom PEG placement was for the sole purpose of gastric decompression were excluded from the study. Each case was reviewed by the gastroenterology

Results

Sixty-seven consultations were requested for evaluation of feeding PEG placement over the 14-month study period. The outcome of these patients is summarized in Figure 1.

. Patient outcome after consultation for feeding PEG placement.

Three patients died within 24 hours of the consultation requested, before initial evaluation by the gastroenterology service. Sixty-four patients (63 inpatients and 1 outpatient) were evaluated for PEG placement. Of these, 6 were excluded because informed consent for

Discussion

Although PEG is now widely available, its impact on patient quality and quantity of life has not been extensively studied in a prospective fashion. There is a debate in the medical community regarding the provision of palliative care to those individuals who lack decision-making capacity.19 Requests for feeding gastrostomies are common in this particular group of patients, especially those who are unable to maintain sufficient caloric intake because of advanced dementia. The 30-day mortality

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    Reprint requests: Richard C. K. Wong, MBBS, FACP, University Hospitals of Cleveland, Division of Gastroenterology, 11100 Euclid Ave., Cleveland, Ohio 44106-5066.

    ☆☆

    R.C.K.W. was the recipient of the 1999 ASGE/ADHF Wilson-Cook Endoscopic Research Career Development Award.

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