Long-term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital*

Low serum albumin level is risk factor for patients with percutaneous endoscopic gastrostomy

OBJECTIVE

In Japan, percutaneous endoscopic gastrostomy (PEG) has been used mainly in patients with stroke and dementia, who undertake oral ingestion voluntarily. We have used PEG for patients with various diseases in Saga Medical School Hospital, including postoperative recovery, malignant disease, and neurodegenerative diseases. This study evaluated prognostic factors in these patients regarding long-term survival.

METHODS

We analyzed retrospectively all patients who received PEG at our hospital. During the period of 1998-2007, 84 patients (32 females, 52 males; mean age, 60.3 years, range 20-89 years) were followed for more than 1 year. We analyzed sex, age, total lymphocyte count, serum albumin level, presence of malignant diseases, cerebrovascular diseases, neurodegenerative disorders, poor general condition after surgical procedures, dementia before PEG, pneumonia before PEG, and complications of PEG placement.

RESULTS

As for diseases, 23 patients had malignant diseases, 27 had cerebrovascular diseases, 19 had neurodegenerative disorders, 16 were in poor general condition after surgery for nonmalignant diseases, and 12 had dementia. Multivariate analysis indicated that risk factors for 1-year survival were low serum albumin level (≤2.9 g/dL), low lymphocyte count, and complications of malignant diseases. Low serum albumin level, low lymphocyte count, and malignant diseases were risk factors, and only the albumin level was a risk factor in those without malignant diseases.

CONCLUSION

Low serum albumin level was a risk factor for 1-year survival with PEG, which suggests that nutrient management before and during PEG placement should be monitored carefully.

Long-term outcome after placement of a percutaneous endoscopic gastrostomy tube

AIM

To evaluate long-term survival and prognostic factors in patients who have undergone placement of a percutaneous endoscopic gastrostomy tube.

METHODS

A retrospective analysis of all patients without malignancy who underwent percutaneous endoscopic gastrostomy at Hanyu General Hospital during the period January 2001-December 2005.

RESULTS

A total of 198 patients (100 men, 98 women) were assessed. Median age was 78 years (range, 25-97 years). The primary diagnosis was a cerebrovascular disorder in 149 (75.3%) of the patients. Prior to placement, 120 (60.6%) had suffered pneumonia. Survival was 87.4% at 1 month, 67.8% at 3 months, 52.6% at 6 months, 38.1% at 1 year, 27.8% at 2 years and 22.3% at 3 years. Pneumonia was the most common cause of death during the follow-up period (91 of 140 patients, 65.0%). Cox's proportional hazards model showed independent predictors of mortality to be a low serum albumin concentration (<or=2.9 g/dL) and history of pneumonia before the procedure.

CONCLUSIONS

Mortality of patients who underwent percutaneous endoscopic gastrostomy appears to be high. In particular, the long-term prognosis was poor for patients with hypoalbuminemia, and this procedure is probably not preferred for patients with recurrent aspiration pneumonia.