Complications and outcome of percutaneous endoscopic gastrostomy in a high-volume centre

Feeding Difficulties and Gastrostomy in Dravet Syndrome: A UK-Wide Survey and 2-Center Experience

Background and Objectives

Dravet syndrome (DS) is one of the most common monogenic epilepsies. Alongside the core seizure and developmental phenotypes, problems with appetite, swallowing, and weight loss are frequently reported, necessitating gastrostomy in some. We explored the burden of feeding difficulties and need for gastrostomy across 3 DS populations in the United Kingdom. We document caregiver opinion and postgastrostomy outcomes, and provide guidance regarding feeding issues and gastrostomy in DS.

Methods

A retrospective, observational study was conducted; data were collected from medical records of 124 individuals with DS attending clinics at the National Hospital for Neurology and Neurosurgery, and Great Ormond Street Hospital, and from 65 DS caregiver responses to a UK-wide survey.

Results

In total, 64 of 124 (52%) had at least 1 feeding difficulty; 21 of 124 (17%) had a gastrostomy, and gastrostomy was being considered in 5%; the most common reasons for gastrostomy were poor appetite (81%) and weight loss/failure to gain weight (71%). Median age at gastrostomy was 17 years (range 2.5-59). Multivariate analyses identified several factors that in combination contributed to risk of feeding difficulties and gastrostomy, including treatment with several antiseizure medications (ASMs), of which stiripentol made a unique contribution to risk of gastrostomy (p = 0.048, odds ratio 3.20, 95% CI 1.01-10.16). Preinsertion, 88% of caregivers were worried about the gastrostomy, with concerns across a range of issues. Postgastrostomy, 88% of caregivers were happy that their child had the gastrostomy, and >90% agreed that the gastrostomy ensured medication compliance, that their child's overall health was better, and that quality of life improved.

Discussion

Feeding difficulties are common in DS, and 17% require a gastrostomy to address these. Risk factors for feeding difficulties in DS are unknown, but ASMs may play a role. There is a high level of caregiver concern regarding gastrostomy preprocedure; however, postgastrostomy caregiver opinion is positive. Feeding difficulties should be proactively sought during review of people with DS, and the potential need for gastrostomy should be discussed.

Complications and survival following percutaneous endoscopic gastrostomy tube placement

INTRODUCTION

Percutaneous endoscopic gastrostomy (PEG) is considered a safe and effective method for nutritional support in patients with malnutrition and swallowing impairment with an estimated survival of over two months. Some indications, such as advanced cognitive decline, contraindicate the technique.

MATERIALS AND METHODS

All patients who underwent PEG placement between January 2001 and May 2019 were included. Clinical data, indication, complications, and mortality were retrospectively analyzed.

RESULTS

A total of 648 patients (46.5% male, mean age 70±18.5 years) were included. The most common indications for PEG were advanced cognitive decline (31.5%) and cerebrovascular disease (18.8%). The mean follow-up was 12.07 months (IQR 3.27-34.73). 39.5% of patients experienced complications (systemic 17.9%, local 28.5%). The most frequent were bronchoaspiration (9.7%) and rupture/dysfunction (13.9%), respectively. The presence of early complications (HR 1.63 [1.20-2.21]) and age (HR 1.02 [1.01-1.02]) were associated with shorter survival time, while female sex was a protective factor (HR 0.78 [0.66-0.94]).

CONCLUSIONS

PEG is not without complications, with 39.5% of patients experiencing them. Patients with advanced dementia, male sex, older age, and systemic complications have lower survival following PEG placement.

Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades

BACKGROUND

Percutaneous endoscopic gastrostomy (PEG) and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children, respectively, requiring long-term enteral nutrition support. Procedure-related mortality is a rare event, often reported to be zero in smaller studies. National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature.

AIM

To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term (< 30 d) and long-term survival.

METHODS

In this retrospective, population-based cohort study, individuals that had received a gastrostomy between 1998-2019 in Sweden were included. Individuals were identified in the Swedish National Patient Register, and survival analysis was possible by cross-referencing the Swedish Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). Kaplan-Meier with log-rank test and Cox regression were used for survival analysis.

RESULTS

In total 48682 individuals (52% males, average age 60.9 ± 25.3 years) were identified. The cohort consisted of 12.0% children, 29.5% adults, and 58.5% elderly. An increased use of gastrostomies was observed during the study period, from 13.7/100000 to 22.3/100000 individuals (P < 0.001). The use of PEG more than doubled (about 800 to 1800/year), with a corresponding decrease in open gastrostomy (about 700 to 340/year). Laparoscopic gastrostomy increased more than ten-fold (about 20 to 240/year). Overall, PEG, open gastrostomy, and laparoscopic gastrostomy constituted 70.0% (n = 34060), 23.3% (n = 11336), and 4.9% (n = 2404), respectively. Procedure-related mortality was 0.1% (n = 44) overall (PEG: 0.05%, open: 0.24%, laparoscopic: 0.04%). The overall 30-d mortality rate was 10.0% (PEG: 9.8%, open: 12.4%, laparoscopic: 1.7%) and decreased from 11.6% in 1998-2009 vs 8.5% in 2010-2019 (P < 0.001). One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases.

CONCLUSION

The annual use of gastrostomies in Sweden increased during the study period, with a shift towards more minimally invasive procedures. Although procedure-related death was rare, the overall 30-d mortality rate was high (10%). To overcome this, we believe that patient selection should be improved.

Prospective randomized controlled trial comparing a novel and dedicated device with conventional endoscopic techniques for the treatment of buried bumper syndrome (with video)

BACKGROUND AND AIMS

Buried bumper syndrome (BBS) is a rare adverse event of PEG tubes. This study compared the newly developed Flamingo device (Fujifilm Medwork GmbH, Höchstadt, Germany) with conventional endoscopic techniques for BBS treatment.

METHODS

This prospective, randomized controlled trial compared the Flamingo set (study group) with other endoscopic techniques (control group) for BBS treatment in 6 German hospitals. The primary endpoint was procedure time. Further outcome parameters were technical success, adverse event rate, and number and cost of devices used in each group.

RESULTS

Thirty-six patients (18 in each group; mean age, 73 years; 12 women) were included in this study between March 2018 and December 2022. Median time since placement of the feeding tube was 30 months. The bumper was located in the gastric corpus in 27 patients, and the internal bumper was completely overgrown in 31 patients. The duration of the removal procedure was 17 minutes (range, 3-72) in the study group compared with 38 minutes (range, 12-111) in the control group (P = .046). The primary technical success rate was 77.8% in the study group and 55.6% in the control group (P = .157), whereas the overall technical success rate was 100% compared with 83.3% (P = .070). Adverse events occurred in 4 patients (11.1%).

CONCLUSIONS

Endoscopic removal of the buried bumper using the Flamingo device was significantly faster than that with other endoscopic techniques and showed a higher technical success rate. This device may become the endoscopic treatment of choice for BBS. (Clinical trial registration number: NCT03186066.).

Evaluation of 644 Percutaneous Endoscopic Gastrostomy Patients in a Single Center

OBJECTIVE

Our study aimed to review and evaluate the indications, complications, complication-related risk factors, and mortality rates of percutaneous endoscopic gastrostomy (PEG) performed in a single university hospital.

METHODS

We retrospectively examined hospital records of all 819 patients who underwent PEG between January 2010 and January 2019. Patients whose information was not available for various reasons, who had a history of gastrectomy, who were under 18 years old, and/or who had undergone PEG before, were excluded from the study.

RESULTS

The mean age of the patients was 65.12 ± 15.42 years, and the majority of the patients (60.6%) were female. In the vast majority of patients, the PEG indication was due to neurological causes (71.5%), among which the majority was a stroke. The overall complication rate in our study was 11.2%. The most common was a peristomal infection in 37 (5.7%) patients. Patients who were not under any antibiotic treatment and/or had diabetes mellitus had a higher risk for peristomal infection. Dementia increased the risk of tube dislodgement. The use of clopidogrel, the simultaneous use of aspirin and clopidogrel, and hypertension were independent risk factors for bleeding complications. The one-year mortality risk was significantly higher in patients who underwent PEG due to neurological causes compared to those who underwent PEG due to malignancy or other reasons (p = 0.021, p = 0.038, respectively).

CONCLUSION

The PEG procedure is a safe and feasible technique due to its low complication and mortality rate in patients with swallowing disorders who need long-term nutritional support.

Severe Acquired Brain Injury: Prognostic Factors of Discharge Outcome in Older Adults

Severe Acquired Brain Injury (sABI) is a leading cause of disability and requires intensive rehabilitation treatment. Discharge from the rehabilitation ward is a key moment in patient management. Delays in patient discharge can adversely affect hospital productivity and increase healthcare costs. The discharge should be structured from the hospital admission toward the most appropriate environment. The purpose of our study is to investigate early predictors of outcome for discharge in older adults with sABI. A retrospective study was performed on 22 patients who were admitted to an intensive neurorehabilitation unit between June 2019 and December 2021. Patients were divided into two outcome categories, good outcome (GO) or poor outcome (PO), based on discharge destination, and the possible prognostic factors were analyzed at one and two months after admission. Among the factors analyzed, changes in the Disability Rating Scale (DRS) and Level of Cognitive Functioning (LCF) at the first and second month of hospitalization were predictive of GO at discharge (DRS, p = 0.025; LCF, p = 0.011). The presence of percutaneous endoscopic gastrostomy at two months after admission was also significantly associated with PO (p = 0.038). High Body Mass Index (BMI) and the presence of sepsis at one month after admission were possible predictors of PO (BMI p = 0.048; sepsis p = 0.014). An analysis of dynamic predictors could be useful to guarantee an early evaluation of hospital discharge in frail patients with sABI.

Mortality and complications after percutaneous endoscopic gastrostomy: a retrospective multicentre study

Background

Percutaneous endoscopic gastrostomy (PEG) is the method of choice for patients in need of long-term nutritional support or gastric decompression. Although it is considered safe, complications and relatively high mortality rates have been reported. We aimed to identify risk factors for complications and mortality after PEG in routine healthcare.

Methods

This retrospective study included all adult patients who received a PEG between 2013 and 2019 in Region Norrbotten, Sweden.

Results

389 patients were included. The median age was 72 years, 176 (45%) were women and 281 (72%) patients received their PEG due to neurological disease. All-cause mortality was 15% at 30 days and 28% at 90 days. Malignancy as the indication for PEG was associated with increased mortality at 90 days (OR 4.41, 95% CI 2.20–8.88). Other factors significantly associated with increased mortality were older age, female sex, diabetes mellitus, heart failure, lower body mass index and higher C-reactive protein levels. Minor and major complications within 30 days occurred in 11% and 15% of the patients, respectively. Diabetes increased the risk of minor complications (OR 2.61, 95% CI 1.04–6.55), while those aged 75 + years were at an increased risk of major complications, compared to those younger than 65 years (OR 2.23, 95% CI 1.02–4.85).

Conclusions

The increased risk of death among women and patients with malignancy indicate that these patients could benefit from earlier referral for PEG. Additionally, we found that age, diabetes, heart failure, C-reactive protein and body mass index all impact the risk of adverse outcomes.

What to do When Decompressive Gastrostomies and Jejunostomies are not Options? A Scoping Review of Transesophageal Gastrostomy Tubes for Advanced Malignancies

BACKGROUND

In advanced malignant bowel obstruction, decompressive gastrostomy tubes (GTs) may not be feasible due to ascites, peritoneal carcinomatosis, and altered gastric anatomy. Whereas nasogastric tubes (NGTs) allow temporary decompression, percutaneous transesophageal gastrostomy tubes (PTEGs) are an alternative method for long-term palliative decompression. This study performed a scoping review to determine outcomes with PTEG in advanced malignancies.

METHODS

A systematic literature search was performed to include all studies that reported the clinical results of PTEGs for malignancy. No language, national, or publication status restrictions were used.

RESULTS

The analysis included 14 relevant studies with a total of 340 patients. In 11 studies, standard PTEGs were inserted with a rupture-free balloon's placement into the mouth or nose and esophageal puncture under fluoroscopy or ultrasound, followed by a guidewire into the stomach with placement of a single-lumen tube. Of 340 patients, 65 (19.1%) had minor complications, and 5 (2.1%) had significant complications, including bleeding and severe aspiration pneumonia. Of 171 patients, 169 with PTEGs (98.8%) reported relief of nasal discomfort from NGT and alleviation of obstructive symptoms. The one randomized controlled trial reported a significantly higher quality of life with PTEGs than with NGTs.

CONCLUSIONS

When decompression for advanced malignancy is technically not feasible with a gastrostomy tube, the PTEG is a viable, safe option for palliation. The PTEG is associated with lower significant complication rates than the gastrostomy tube and significantly higher patient-derived outcomes than the NGT.

An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit

Critically ill patients are at increased risk for malnutrition as they often have underlying acute and chronic illness, stress related catabolism, decreased appetite, trauma and ongoing inflammation. Malnutrition is recognized as a leading cause of adverse outcomes, higher mortality, and increased hospital costs. Percutaneous endoscopic gastrostomy (PEG) tubes provide a safe and effective route to provide supplemental enteral nutrition to these patients. PEG placement has essentially replaced surgical gastrostomy as the modality of choice for longer term feeding in patients. This is a highly prevalent procedure with 160,000 to 200,000 PEG procedures performed each year in the United States. The purpose of this review is to provide an overview of current knowledge and practice standards with regards to placement of PEG tube in the Intensive Care Unit (ICU). When a patient is considered for a PEG tube, it is important to evaluate the treatment alternatives and identify the best option for each patient. In this review, we provide the advantages and disadvantages of various feeding modalities and devices. We review the indications and contraindications for PEG tube placement as well as the risks of this procedure. We then describe in detail the per-oral pull, per-oral push, and direct percutaneous techniques for PEG tube placement. Additionally, we review the feasibility of having interventional pulmonologists place PEG tubes in the ICU.

In Home Caregivers' Experiences With Percutaneous Endoscopic Gastrostomy Patients: A Qualitative Review

In home caregivers of patients with percutaneous endoscopic gastrostomy face physical, social, and psychological problems. The results of qualitative studies play a key role in determining in home caregivers' percutaneous endoscopic gastrostomy-related problems, attitudes, views, and experiences. The aim of this review was to survey the literature to assess the problems faced by in home caregivers of percutaneous endoscopic gastrostomy patients and identify solutions to these problems. PubMed, Cochrane, and Web of Science databases were screened using the key words qualitative research, percutaneous endoscopic gastrostomy, enteral nutrition, and mixed method for relevant articles published between 1945 and November 2019. The literature search yielded 446 scholarly articles. Their titles and abstracts were screened for possible inclusion in this review. Fifteen articles that met the inclusion criteria were included in the study. The quality of the included qualitative articles were assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist, whereas mixed-methods articles were assessed using the Mixed Methods Appraisal Tool. Five major themes were developed: percutaneous endoscopic gastrostomy tube problems, training requirement, health support system, effect on life, and tube necessity. We believe that determining caregivers' physical and psychosocial problems around managing patients' percutaneous endoscopic gastrostomy tubes and developing support systems can help solve those problems and improve both patients' and caregivers' quality of life.

Prevention and management of major complications in percutaneous endoscopic gastrostomy

Background

Percutaneous endoscopic gastrostomy is a commonly used endoscopic technique where a tube is placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition. Several placement techniques are described in the literature with the ‘pull’ technique (Ponsky-Gardener) as the most popular one. Independent of the method used, placement includes a ‘blind’ perforation of the stomach through a small acute surgical abdominal wound. It is a generally safe technique with only few major complications. Nevertheless these complications can be sometimes life-threatening or generate serious morbidity.

Method

A narrative review of the literature of major complications in percutaneous endoscopic gastrostomy.

Results

This review was written from a clinical viewpoint focusing on prevention and management of major complications and documented scientific evidence with real cases from more than 20 years of clinical practice.

Conclusions

Major complications are rare but prevention, early recognition and popper management are important.

Predictive factors of complications and 30-day mortality in patients undergoing percutaneous endoscopic gastrostomy: the utility of C-reactive protein to albumin ratio

BACKGROUND AND STUDY AIMS

Percutaneous endoscopic gastrostomy (PEG) is a procedure that provides long term enteral nutrition. To investigate the predictors of PEG-related complications and 30-day mortality rates and evaluate the indicators for deciding whether to recommend elective PEG insertions, we sought to determine the complications and early mortality rates of patients who underwent PEG.

PATIENTS AND METHODS

We performed a retrospective analysis of consecutive adult patients who had undergone PEG for the first time between October 2016 and January 2019. The predictors of complications and 30-day mortality were analyzed with receiver operating characteristic (ROC) and logistic regression analysis.

RESULTS

This study included 309 patients. Patients were excluded from the study if they were < 18 years of age or there were missing data about them. Out of 253 patients, 33 (13%) had complications and 32 (12.6%) died within one month after PEG insertion. A higher C-reactive protein (CRP) to albumin ratio was the only independent factor predicting the complications (odds ratio (OR) : 3.17 ; 95% CI : 1.26-8.00 ; p = 0.014). The independent predictive factors for 30-day mortality after PEG placement included higher urea levels and higher CRP to albumin ratios (OR : 3.78 ; 95% CI : 1.41-10.17 ; p = 0.008) (OR : 6.67 ; 95% CI : 1.87- 23.75 ; p = 0.003). The only predictor for both complications and 30-day mortality was the CRP to albumin ratio.

CONCLUSIONS

When appropriate, the PEG procedure can provide a safe and effective method for enteral feeding. The CRP to albumin ratio can be used to predict complications and early mortality after PEG insertion. Because PEG is elective, higher CRP to albumin ratios can be helpful in deciding to select patients for the procedure.

Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy

Background and Aim

Percutaneous endoscopic gastrostomy (PEG) has been used in patients with dysphagia and inadequate food intake via an oral route. Despite being a procedure with a high success rate, complications and death have been reported. The aim was to identify the factors related to major complications and mortality, as well as PEG removal prognostic factors due to improvement of their general condition.

Methods

Patient characteristics, comorbidities, laboratory data, concomitant medication, sedation, and indication for PEG placement were collected. Major complications, mortality, and PEG removal factors were assessed.

Results

A total of 388 patients were enrolled. There were 15 (3.9%) cases of major complications, with major bleeding being the most frequent in 6 (1.5%) patients. Corticosteroids were the independent variable associated with major complications (odds ratio [OR] 5.85; 95% confidence interval [CI] 1.71–20; P = <0.01). Advanced cancer (hazard ratio [HR] 0.5; 95% CI 0.3–1; P = 0.05), albumin (HR 0.6; 95% CI 0.4–0.9; P = <0.01), and C‐reactive protein (CRP) (HR 1.1; CI 1–1.2; P = 0.01) were considered risk factors for mortality. Previous pneumonia (HR 0.4; CI 0.2–0.9; P = 0.02) was a factor for permanent use of a PEG; however, oncological indication (HR 8.2; CI 3.2–21; P = <0.01) was factors for PEG withdrawal.

Conclusions

Chronic corticosteroid users potentially present with major complications. Low albumin levels and elevated CRP were associated with death. Previous aspiration pneumonia was a factor associated with permanent use of PEG; however, patients with oncological indication were the most benefited.

Endoscopic management of enteral tubes in adult patients - Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

ESGE recommends the "pull" technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer ("push") technique for PEG placement in cases where the "pull" method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed "blindly" at the patient's bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 - 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 - 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.

Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

ESGE recommends considering the following indications for enteral tube insertion: (i) clinical conditions that make oral intake impossible (neurological conditions, obstructive causes); (ii) acute and/or chronic diseases that result in a catabolic state where oral intake becomes insufficient; and (iii) chronic small-bowel obstruction requiring a decompression gastrostomy.Strong recommendation, low quality evidence.ESGE recommends the use of temporary feeding tubes placed through a natural orifice (either nostril) in patients expected to require enteral nutrition (EN) for less than 4 weeks. If it is anticipated that EN will be required for more than 4 weeks, percutaneous access should be considered, depending on the clinical setting.Strong recommendation, low quality evidence.ESGE recommends the gastric route as the primary option in patients in need of EN support. Only in patients with altered/unfavorable gastric anatomy (e. g. after previous surgery), impaired gastric emptying, intolerance to gastric feeding, or with a high risk of aspiration, should the jejunal route be chosen.Strong recommendation, moderate quality evidence.ESGE suggests that recent gastrointestinal (GI) bleeding due to peptic ulcer disease with risk of rebleeding should be considered to be a relative contraindication to percutaneous enteral access procedures, as should hemodynamic or respiratory instability.Weak recommendation, low quality evidence.ESGE suggests that the presence of ascites and ventriculoperitoneal shunts should be considered to be additional risk factors for infection and, therefore, further preventive precautions must be taken in these cases.Weak recommendation, low quality evidence.ESGE recommends that percutaneous tube placement (percutaneous endoscopic gastrostomy [PEG], percutaneous endoscopic gastrostomy with jejunal extension [PEG-J], or direct percutaneous endoscopic jejunostomy [D-PEJ]) should be considered to be a procedure with high hemorrhagic risk, and that in order to reduce this risk, specific guidelines for antiplatelet or anticoagulant use should be followed strictly.Strong recommendation, low quality evidence.ESGE recommends refraining from PEG placement in patients with advanced dementia.Strong recommendation, low quality evidence.ESGE recommends refraining from PEG placement in patients with a life expectancy shorter than 30 days.Strong recommendation, low quality evidence*.

Metastasis to the gastrostomy site in a patient with pharynx cancer after percutaneous endoscopic gastrostomy: a case report

A stenosing tumour in the throat region is a common indication for percutaneous endoscopic gastrostomy (PEG), which may be used for enteral nutrition in palliative cases or placed prior to curative treatment (surgery, radiotherapy and/or chemotherapy) and removed when the patient has recovered and has a reliable and adequate oral intake. Major complications related to PEG are rare, but their treatment poses a challenge. We are presenting a case of the transmission of metastasis to the gastrostomy site in a patient with pharynx cancer after percutaneous endoscopic gastrostomy.

Nursing-Based Guidelines for Caregivers regarding Adult Patients with Percutaneous Endoscopic Gastrostomy

Background:

Percutaneous Endoscopic Gastrostomy (PEG) may cause complications when the management is inadequate and inappropriate. To avoid these complications, caregivers’ experiences and practices must be considered.

Study Aim:

This study aimed to evaluate the effect of nursing- based guidelines on caregivers’ knowledge and practices regarding adult patients with percutaneous endoscopic gastrostomy.

Methods:

A quasi-experimental design was used. The study was conducted in the medical and surgical departments in the National Cancer Institute, Cairo University, Egypt. Sample: The sample consisted of 30 patients with PEG and their caregivers. A Structured interviewing questionnaire, Self-Administered Structured Questionnaire for caregiver, Caregiver Performance observation checklist, and PEG-specific questionnaire were obtained for data collection

Results:

The majority of studied patients (86.7%) were suffering from oncologic problems, in post-test and following up, the majority (83.3%) of caregivers had satisfactory level (76.7) (90%) (70%) in knowledge, complication and management of PEG, respectively. During follow up, the majority (73.3%) (90%) of caregivers were well level as regarding nutritional management and care of PEG. There were statistically significant differences between pre/post and follow-up nursing-based guidelines for caregivers’ knowledge and practice regarding patients with percutaneous endoscopic gastrostomy. The results show an improvement in the patients outcomes and the level of caregiver coping with the care of PEG and overall Patient satisfaction at (χ2 = 3.844, 4.097) p<0.001

Conclusion:

Nursing-based guidelines were helpful in the improvement of the caregiver's knowledge and practice regarding percutaneous endoscopic gastrostomy.

Recommendations

Periodic educational training programs regarding PEG were based on the best practice guidelines for caregivers of those patients.

Clinical Outcomes of Enteral Feeding Protocol Via Percutaneous Endoscopic Gastrostomy: A Single-Center, Retrospective Study

BACKGROUND

The development of the endoscopic technique has resulted in an increasing number of patients undergoing percutaneous endoscopic gastrostomy (PEG) insertion; however, the protocols for increasing the volume of feeding formula after PEG insertion have not been established. Therefore, we compared the clinical outcomes of patients receiving low- and high-volume increase in enteral feeding formula.

METHODS

A total of 215 patients who underwent PEG insertion between January 2016 and March 2019 were included. They were divided into 2 groups according to the increase in volume of feeding formula: the low-volume group (n = 135) received ≤150 mL/d, and the high-volume group (n = 80) received ≥300 mL/d. Patient characteristics, procedure, and feeding-related clinical outcomes were retrospectively reviewed using medical records.

RESULTS

The adverse events of the feeding protocol did not significantly differ between the 2 groups. The number of days needed to attain the calorie targets was significantly lower in the high-volume group than in the low-volume group (5.4 ± 3.0 vs 2.4 ± 1.5; P < .001). The duration of supplemental parenteral nutrition and the length of hospitalization were also significantly lower in the high-volume group (3.9 ± 3.3 vs 1.2 ± 2.2; P < .001 and 5.8 ± 2.7 vs 4.6 ± 2.6; P = .007, respectively).

CONCLUSION

To rapidly attain the calorie targets in appropriately selected patients with PEG insertion, a high-volume increase in daily feeding can safely be recommended given the favorable outcomes.

Percutaneous endoscopic gastrostomy: dealing with the issue of dislodgement

Introduction: Percutaneous Endoscopic Gastrostomy (PEG) is accepted as an efficient method to provide long-term enteral nutrition. PEG accidental dislodgement (device exteriorization confirmed by expert evaluation) rate is high and can lead to major morbidity.Objective: To identify independent risk factors for PEG accidental dislodgement.Methods: Retrospective, single-center study, including consecutive patients submitted to PEG procedure, for 38 consecutive months. Every patient had 12 months minimum follow-up after PEG placement. Univariate analysis selected variables with at least marginal association (p < .15) with the outcome variable, PEG dislodgement, which were included in a logistic regression multivariate model. Discriminative power was assessed using area under curve (AUC) of the receiver operating curve (ROC).Results: We included 164 patients, 67.7% (111) were female, mean age was 81 years. We report 59 (36%) PEG dislodgements, of which 13 (7.9%) corresponded to early dislodgements. The variables with marginal association were hypoalbuminemia (p = .095); living at home (p = .049); living in a nursing home (p = .074); cerebrovascular disease (CVD) (p = .028); weight change of more than 5 kg, either increase or decrease (p = .001); psychomotor agitation (p < .001); distance inner bumper-abdominal wall (p = .034) and irregular appointment follow-up (p = .149). At logistic multivariate regression, the significant variables after model adjustment were CVD OR 4.8 (CI 95% 2.0-11.8), weight change OR 4.7 (CI 95%1.6-13.9) and psychomotor agitation OR 18.5 (CI 95% 5.2-65.6), with excellent discriminative power (AUC ROC 0.797 [CI95% 0.719-0.875]).Conclusion: PEG is a common procedure and accidental dislodgement is a frequent complication. CVD, psychomotor agitation and weight change >5 kg increase the risk of this complication and should be seriously considered when establishing patients' individual care requirements.

Simple Bedside Predictors of Survival after Percutaneous Gastrostomy Tube Insertion

BACKGROUND

Percutaneous endoscopic gastrostomy (PEG) tube insertion is an increasingly used minimally invasive method for long-term enteral feeding. Identification of simple predictors for short-term mortality (up to one month) after PEG insertion is of paramount importance.

AIM

We aimed to explore a simple noninvasive parameter that would predict survival following PEG insertion.

METHODS

We performed a retrospective study of all patients who underwent PEG insertion at the Galilee Medical Center from January 1, 2014 to December 30, 2018. We collected simple clinical and laboratory parameters and survival data and looked for predictors of short-term mortality.

RESULTS

A total of 272 patients who underwent PEG insertion were included. Sixty-four patients (23.5%) died within one month after PEG insertion compared to 208 patients (76.5%) who survived for more than one month. Univariate analysis revealed several short-term mortality-related predictors, including older age (OR 1.1, P=0.005), ischemic heart disease (OR 2, P=0.0197), higher creatinine level (OR 2.3, P=0.0043), and elevated CRP level and CRP-to-albumin ratio (OR 1.1, P < 0.0001; OR 1.0031, P < 0.0001, respectively). In multivariate logistic analysis, older age (OR 1.1, P=0.019), higher creatinine level (OR 1.6, P=0.074), and elevated CRP-to-albumin ratio (OR 1.1, P=0.002) remained significant predictors of short-term mortality after PEG insertion with an ROC of 0.7274.

CONCLUSION

We could identify several simple parameters associated with high risk of mortality, and we recommend considering using these parameters in decision-making regarding PEG insertion. Further prospective studies are needed to validate our findings.