Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study

A dedicated feeding tube clinic reduces emergency department utilization for gastrostomy tube complications

INTRODUCTION

Enteral access is required for a variety of reasons from neuromuscular disorders to dysphagia. Gastrostomy tubes (GTs) can be placed endoscopically, surgically, or radiographically and complications include infection, bleeding, leakage and unintentional removal. Routine post-procedural follow-up is limited by inconsistent guidelines and management by different specialty teams. We established a dedicated GT clinic to provide continuity of care and prophylactic GT exchange. We hypothesized that patients followed in the GT clinic would have reduced Emergency Department (ED) utilization.

METHODS

A retrospective review of patients who underwent GT placement from January 2010 to January 2020 was conducted. Baseline demographics, indications for GT placement, number and reason for ED visits and utilization of a multidisciplinary GT clinic were studied.

RESULTS

A total of 97 patients were included. The most common indication for placement was dysphagia (88, 91%) and the most common primary diagnosis was head and neck malignancy (51, 51%). The GT clinic is a multidisciplinary clinic staffed by surgeons and residents, dieticians, and wound care specialists and cared for 16 patients in this study. Three patients (19%) in the GT clinic group required ED visits compared to 44 (54%) in the standard of care (SOC) group (p < 0.05). There was an average of 0.9 ED visits per patient (range 0-7) in the GT clinic group vs 1.6 ED visits per patient (range 0-20) in the SOC group (p = 0.34). Feeding tubes were prophylactically exchanged an average of 7 times per patient in the GT clinic group vs 3 times per patient in the SOC group (p < 0.05).

CONCLUSION

A multidisciplinary clinic dedicated to GT care limits ED visits for associated complications by more than 50%. Follow-up in a dedicated clinic with prophylactic tube exchange decreases ED visits and should be considered at facilities that care for patients with GTs.

Gastrostomy Tube Insertion Complications and Patient Care Outcomes in a Tertiary Care Hospital

Background

Percutaneous endoscopic gastrostomy (PEG) is a widely known procedure where an endoscopist inserts a tube through the stomach to provide enteral nutrition. The existing literature shows inconsistent results regarding complication rates, and very few studies have examined the relationship between patient characteristics and PEG outcomes. Therefore, we aimed to investigate PEG tube insertion outcomes and determine different variables associated with these outcomes.

Methods

This retrospective record review included 207 patients who underwent PEG tube insertion at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between 2010 and 2021. We obtained variables such as demographics, complications, and length of hospitalization. The Student t-test, chi-square test, and Mann-Whitney test were used in the data analysis.

Results

Of 207 patients, 106 were male (51.2%). The patient's median age was 10 years, and the median length of hospital stay was two days. The PEG-related complication rate was 32.4%, while the 1-year adverse outcome rate was 44.9%. The most common complications were unspecified fever (21.3%) and vomiting (14%). We found a significant relationship between dysphagia and length of hospitalization (P=0.015) and between age and the occurrence of tube leakage (P=0.021). Another significant relationship was found between the number of PEG insertions and gastrostomy-site infection (P=0.046).

Conclusions

This study's results indicate the importance of a thorough review of patients' medical records; some patient characteristics can be valuable predictors of PEG outcomes. Thus, we urge physicians to study each patient to anticipate PEG tube insertion outcomes carefully. Moreover, we recommend that researchers with access to larger patient registries study more variables to reach unified guidelines that ensure the best possible outcomes.

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.

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.