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Gombošová L, Deptová J, Jochmanová I, Svoreňová T, Veseliny E, Zakuciová M, Haň V, Lacková A, Kulcsárová K, Ostrožovičová M, Ventosa JR, Trcková L, Lazúrová I, Škorvánek M. Endoscopic Complications Are More Frequent in Levodopa-Carbidopa Intestinal Gel Treatment via JET-PEG in Parkinson's Disease Patients Compared to Nutritional PEG in Non-Parkinson's Disease Patients. J Clin Med 2024; 13:703. [PMID: 38337398 PMCID: PMC10856619 DOI: 10.3390/jcm13030703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: To date, no studies comparing complication rates between patients with nutritional percutaneous endoscopic gastrostomy (N-PEG) and Parkinson's disease (PD) patients with percutaneous endoscopic gastro-jejunostomy (JET-PEG) for treatment administration have been published. Our study aimed to compare complication rates and the number of re-endoscopies between N-PEG and JET-PEG patients. Methods: Individuals requiring N-PEG or JET-PEG insertion between 2014 and 2021 were included in this single-center retrospective observational study. Complications were divided into time-related medical and technical complications. Reasons for post-insertion re-endoscopies and their number were also analyzed. Results: Eighty-seven subjects, 47 (54.02%) in JET-PEG group and 40 (45.98%) in the N-PEG group, were included. Early and technical complications were more frequent in JET-PEG vs. N-PEG subjects (70% vs. 10% [p < 0.001], and 54.5% vs. 5.1% [p < 0.001], respectively). The presence of psychiatric disease was associated with a higher number of early complications (p < 0.002). All three types of complications were significantly more frequent in subjects where a healthcare professional did not handle PEG (p < 0.001). Subjects with JET-PEG required a higher number of re-endoscopies compared to the N-PEG group (57.1% vs. 35%, p = 0.05). Conclusions: Complications are significantly more common in individuals with JET-PEG than those with N-PEG, which can be attributed to higher mobility in PD patients.
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Affiliation(s)
- Laura Gombošová
- 2nd Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (E.V.); (M.Z.)
| | - Jana Deptová
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (I.J.); (I.L.)
| | - Ivana Jochmanová
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (I.J.); (I.L.)
| | - Tatiana Svoreňová
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Eduard Veseliny
- 2nd Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (E.V.); (M.Z.)
| | - Mária Zakuciová
- 2nd Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (E.V.); (M.Z.)
| | - Vladimír Haň
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Alexandra Lacková
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Kristína Kulcsárová
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
- Department of Clinical Neurosciences, University Scientific Park MEDIPARK, Pavol Jozef Šafárik University, 04001 Košice, Slovakia
| | - Miriama Ostrožovičová
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Joaquim Ribeiro Ventosa
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
- Department of Clinical Neurosciences, University Scientific Park MEDIPARK, Pavol Jozef Šafárik University, 04001 Košice, Slovakia
| | - Lenka Trcková
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Ivica Lazúrová
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (I.J.); (I.L.)
| | - Matej Škorvánek
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
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Predictive factors of complications and 30-day mortality in patients undergoing percutaneous endoscopic gastrostomy: the utility of C-reactive protein to albumin ratio. Acta Gastroenterol Belg 2021; 84:283-288. [PMID: 34217176 DOI: 10.51821/84.2.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
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.
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Limpias Kamiya KJL, Hosoe N, Takabayashi K, Hayashi Y, Fukuhara S, Mutaguchi M, Nakamura R, Kawakubo H, Kitagawa Y, Ogata H, Kanai T. Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy. JGH OPEN 2021; 5:590-598. [PMID: 34013060 PMCID: PMC8114989 DOI: 10.1002/jgh3.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/27/2021] [Accepted: 03/18/2021] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Kenji J L Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Makoto Mutaguchi
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Rieko Nakamura
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Hirofumi Kawakubo
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Yuko Kitagawa
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Keio University School of Medicine Tokyo Japan
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Joundi RA, Saposnik G, Martino R, Fang J, Kapral MK. Development and Validation of a Prognostic Tool for Direct Enteral Tube Insertion After Acute Stroke. Stroke 2020; 51:1720-1726. [PMID: 32397928 DOI: 10.1161/strokeaha.120.028949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to create a novel prognostic risk score to estimate outcomes after direct enteral tube placement in acute stroke. Methods- We used the Ontario Stroke Registry and linked databases to obtain clinical information on all patients with direct enteral tube insertion after ischemic stroke or intracerebral hemorrhage from July 1, 2003 to June 30, 2010 (derivation cohort) and July 1, 2010 to March 31, 2013 (validation cohort). We used multivariable regression to assign scores to predictor variables for 3 outcomes after tube placement: favorable outcome (discharge modified Rankin Scale score 0-3 and alive at 90 days), poor outcome (discharge modified Rankin Scale score 5 or death at 90 days), and 30-day mortality. Results- Variables associated with a favorable outcome were younger age, preadmission independence, ischemic stroke rather than intracerebral hemorrhage, lower stroke severity, and a shorter time between stroke and tube placement. Variables associated with a poor outcome were older age, preadmission dependence, atrial fibrillation, greater stroke severity, and tracheostomy. Age, preadmission dependence, atrial fibrillation, cancer, chronic obstructive pulmonary disease, and shorter time to tube placement were associated with increased 30-day mortality. Using these variables, we created an online calculator to facilitate estimation of individual patient risk of favorable and poor outcomes. C-statistic in the validation cohort was 0.82 for favorable outcome, 0.65 for poor outcome, and 0.62 for 30-day mortality, and calibration was adequate. Conclusions- We developed risk scores to estimate outcomes after direct enteral tube insertion for acute dysphagic stroke. This information may be useful in discussions with patients and families when there is prognostic uncertainty surrounding outcomes with direct enteral tube placement after stroke.
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Affiliation(s)
- Raed A Joundi
- From the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary (R.A.J.).,ICES, Toronto, Canada (R.A.J., G.S., J.F., M.K.K.)
| | - Gustavo Saposnik
- ICES, Toronto, Canada (R.A.J., G.S., J.F., M.K.K.).,Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital (G.S.), University of Toronto, Canada.,Institute of Health Policy, Management and Evaluation (G.S.), University of Toronto, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology (R.M.), University of Toronto, Canada.,Graduate Department of Rehabilitation Science (R.M.), University of Toronto, Canada.,Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Canada (R.M.)
| | - Jiming Fang
- ICES, Toronto, Canada (R.A.J., G.S., J.F., M.K.K.)
| | - Moira K Kapral
- ICES, Toronto, Canada (R.A.J., G.S., J.F., M.K.K.).,Division of General Internal Medicine, Department of Medicine (M.K.), University of Toronto, Canada.,Institute of Health Policy, Management, and Evaluation (M.K.), University of Toronto, Canada
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Iturbide-Casas MA, Cámara-Martos F, Molina-Luque R, Molina-Recio G. Survival Analysis of Enterally Fed Patients: Prognosis and Mortality Risk According to Baseline Characteristics. JPEN J Parenter Enteral Nutr 2019; 44:1057-1065. [PMID: 31736137 DOI: 10.1002/jpen.1745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/09/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Enteral nutrition is widely used. However, its benefits remain unclear in specific conditions like dementia. This study assesses the survival of enterally fed patients and the baseline characteristics associated with higher mortality. METHODS A retrospective analysis of biochemical and clinical data from 377 patients (age 77.5 ± 13.8) who received enteral tube feeding (ETF) at a tertiary hospital in Spain was performed. Kaplan-Meier and Cox regressions were used to analyze survival expectancy and mortality risk (MR). Risk was evaluated for 30/180 days and up to 5 years. RESULTS The most common individual diagnoses leading to ETF prescription were dementia (37.9%) and head/neck/upper-gastrointestinal-tract cancer (17.5%). Comorbidities (high blood pressure [HBP] and/or diabetes) were present in 72.4% of patients. The first 30 days after tube placement showed the highest mortality rate, corresponding to 85.4% of patients that did not continue being tube-fed. Multivariate Cox analysis (P < .05, 95% CI) showed HBP and glycemia to be predictive of overall (hazard ratio [HR] = 1.600; HR = 1.756) and long-term (HR = 3.092; HR = 4.539) death. In the short-term, only glycemia showed an increased MR (HR = 1.572). CONCLUSION This enterally fed population showed a noticeably high initial mortality rate. Despite official recommendations against it, ETF is very common in advanced dementia. Baseline characteristics are useful for identifying patients that would be less benefited by the intervention. Accordingly, families should be informed about realistic outcomes and risks derived from this procedure.
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Affiliation(s)
| | - Fernando Cámara-Martos
- Departamento de Bromatología y Tecnología de los Alimentos, Universidad de Córdoba, Córdoba, Spain
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Shangab MOM, Shaikh NA. Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study. Ann Gastroenterol 2019; 32:469-475. [PMID: 31474793 PMCID: PMC6686100 DOI: 10.20524/aog.2019.0409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Percutaneous endoscopic gastrostomy (PEG) is a popular method for long-term enteral feeding. Our aim was to determine potential risk factors for adverse events related to PEG, as well as consequent prolonged hospitalization. Methods: Data were retrospectively collected from the admission records of a tertiary center between July 2015 and June 2018. Possible predictors of the 3 following outcomes were evaluated: minor PEG-related adverse events, major PEG-related adverse events, and length of hospital stay. Data were tested for correlation using the Spearman coefficient and for association using Kruskal-Wallis tests for significance. Results: A total of 362 admissions involving 146 patients were included in the study. Of the admissions, 221 (61.0%) had only minor adverse events, 100 (27.6%) had only major adverse events, and 41 (11.3%) had both. Eighty (22.1%) had PEG-site infection and 128 (35%) had aspiration pneumonia. Serum albumin levels at presentation were negatively correlated with the length of hospitalization (P<0.001), which also differed between patients presenting with major and minor adverse events (P<0.001 and P=0.026). The Charlson comorbidity index was positively correlated with the duration of hospitalization (P<0.001). Higher index scores were found more among patients presenting with aspiration pneumonia (P=0.004) and lower scores were found among patients presenting with PEG site infection and inadvertent PEG removal compared with those presenting with a major complication (P<0.001). Conclusion: The patient’s general medical condition and nutritional status are the greatest risk predictors for developing adverse events related to their PEG feeding, as well as a consequent extended hospital stay.
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Toh Yoon EW, Yoneda K, Nishihara K. Percutaneous endoscopic gastrostomy for enteral nutrition: a 5-year clinical experience with 324 patients. MINERVA GASTROENTERO 2019; 65:20-29. [PMID: 30676011 DOI: 10.23736/s1121-421x.18.02535-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is considered the route of choice for long-term enteral nutrition. In this study, we evaluated the short term outcomes of PEG and aimed to identify the risk factors for in-hospital mortality as well as adverse events such as aspiration pneumonia. METHODS Three hundred and twenty-four patients who received PEG for enteral nutrition between January 2007 and December 2011 were included in this study. Data regarding baseline characteristics, preoperative biomarkers and clinical outcomes were collected and analyzed. RESULTS The average patient age was 82.3±10.9 (SD) years old. 149 patients (46%) were men and 199 patients (61%) had stroke as a comorbidity. Postoperatively, feeding-related aspiration pneumonia was observed in 72 patients (22%), diarrhea in 40 patients (12%) and peristomal infection in 34 patients (11%). The average postoperative length of stay was 34.6 days. 51 patients (16%) died before discharge, 22 (6.8%) of them within 30 days after PEG. Two deaths (0.6%) were considered procedure-related (bleeding). Multivariate analysis revealed the male gender, lower serum albumin levels and higher blood urea nitrogen (BUN) levels as significant prognostic factors for in-hospital mortality. Higher C-reactive protein levels and BUN levels were found to be independently associated with the occurrence of postoperative aspiration pneumonia. CONCLUSIONS Our experience reconfirmed PEG as a minimally invasive and safe procedure for long-term enteral nutrition in patients with impaired oral intake. However, significant prognostic factors should be taken into account during the preoperative evaluation of patients. Deferral of procedure or specialized postoperative care may be indicated in high risk patients.
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Affiliation(s)
- Ezekiel W Toh Yoon
- Department of Gastroenterology and Hepatology, Hiroshima Kyoritsu Hospital, Hiroshima, Japan -
| | - Kaori Yoneda
- Endoscopy Center, Hiroshima Kyoritsu Hospital, Hiroshima, Japan
| | - Kazuki Nishihara
- Department of Gastroenterology and Hepatology, Hiroshima Kyoritsu Hospital, Hiroshima, Japan
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Indrayan A. Statistical medicine: An emerging medical specialty. J Postgrad Med 2017; 63:252-256. [PMID: 29022563 PMCID: PMC5664870 DOI: 10.4103/jpgm.jpgm_189_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/08/2017] [Accepted: 08/12/2017] [Indexed: 12/02/2022] Open
Abstract
A large number of statistical tools are now used for medical decision in the core activities of diagnosis, treatment and prognosis. These tools provide undeniable help in improving medical outcomes. Prominent among them are uncertainty measurement by probability, medical indicators and indexes, reference ranges, and scoring systems. In addition are tools such as odds ratio, sensitivity, specificity and predictivities, area under the ROC curve, likelihood ratios, and cost-benefit analysis that are commonly applied in medical research but have implications for day-to-day clinical activities. These tools have so completely integrated into medical practice that statistical medicine by itself can stand alone as a medical specialty. Time has arrived to recognize statistical medicine as a medical specialty.
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Affiliation(s)
- A Indrayan
- Former Professor & Head, Department of Biostatistics and Medical Informatics, University College of Medical Sciences, Delhi, India
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