Incidental Findings on Peg Placement May Indicate Procedure Deferment

Abstract

Purpose: Percutaneous endoscopic gastrostomy (Peg) placement is often performed in cases of persistent refusal to take in adequate intake or with patients with difficulty in swallowing. These patients often suffer from dementia and may be nonverbal. They are unable to communicate pain or discomfort. Swallow studies are performed in part to document the degree of dysphagia and to recommend PEG placement when indicated. Calorie counts are also performed to document poor intake. These studies do not address the underlying etiology for the patients change in appetite. A patients refusal to take in nutrition may be multifactorial. A possible treatable gastrointestinal source may be the cause for the decreased oral intake. Methods: We conducted a retrospective analysis of a 135 consecutive patients. These patients were admitted between 8/03 and 3/05. All patients who underwent endoscopy for the purpose of PEG placement were included regardless if placement was successful. None of the patients had previous peg placement. The study was performed at a university teaching hospital Results: A total of 131 out of 135 procedures were completed with successful PEG placement. Two of the four patients who had placement deferred had endoscopies where adequate landmarks for placement could not be identified. Two previously unknown gastric cancers were discovered at the time of endoscopy in the remaining two patients who had unsuccessful placement. A total of 7 duodenal ulcers, 6 gastric ulcers were noted. Other findings included esophagitis (14), gastritis (28) and duodenitis (13) Conclusion: Serious endoscopic findings are often found while PEG placement is being performed. These findings may often explain why a patient who suffers from dementia may refuse oral intake. Therapy such as proton pump inhibitors may be effective in treating acute gastrointestinal problems allowing the resumption of adequate oral nutrition. Further prospective studies may be necessary to assess if treating such findings may obviate the need for peg placement.