Percutaneous Endoscopic Gastrostomy in Diabetic Patients

Abstract

Purpose: Percutaneous Endoscopic Gastrostomy (PEG) is a procedure of choice for enteral nutrition in patients with functional gastrointestinal tract. PEG has been performed in patients with multiple co morbidities with a low morbidity and mortality including patients with Diabetes. Review of literature shows that there are very few published studies analyzing the complications of PEG placement in diabetic patients. The aim of our study was to compare complications of PEG placement in diabetic patients with non diabetic patients to find any possible difference in mortality or morbidity between the two groups. Methods: All patients who underwent percutaneous endoscopic gastrostomy in IMC as inpatients from January 2005 to March 2007 were included in the study. All patients who had PEG placement on ambulatory basis were excluded from this study. There were total 104 patients out of whom 91 were women and 13 men. Group 1 (DM group) consist of 36 patients, Male 5, Female 31. Group 2 (non DM group) consists of 68 patients, (Male 8, Female 60). Indications for PEG placement in DM group included various neurologic impairment like Alzheimer's dementia 8 (22.2%), Cerebrovascular accident 21 (58.3%) and chronic ventilator dependent 7 (19.4%). Indications for PEG in non DM patients were neurological impairment like Alzheimer's Dementia 33 (48.5%), Cerebrovascular accident 26 (38.2%) and chronic vent dependent 10 (14.7%). Patients received preoperative antibiotics as short-term prophylaxis. Results: All PEG complications were compared between DM (group1) and non DM (group2) patients. Wound infection (group1) 2, (group2) 5 (P 0.54), peristomal leakage (group1) 1, (group2) 2 (P 0.3), inadvertent PEG removal (group1) 10, (group2) 16 (P 0.402). Mortality unrelated to PEG placement in (group1) 12, (group2) 8 (P 0.432). There were no significant differences in mortality or morbidity between diabetic and non diabetic patients. In addition there was no statistically significant difference in complications among diabetic patients whether on insulin or oral hypoglycemic agents. Other complications of PEG like bleeding, necrotizing fasciitis, esophageal/gastric perforation, colocutaneous fistula, buried bumper syndrome, peritonitis, pneumoperitoneum, paralytic ileus, gastric outlet obstruction and death secondary to PEG placement were not reported in either group. Conclusion: Although diabetes mellitus is considered to be associated with more post operative wound complications, our study did not show any statistically significant increase in morbidity or mortality of PEG in diabetic patients when compared to non diabetics. It is suggested that PEG is a safe procedure in diabetic patients.