Percutaneous Endoscopic Gastrostomy Tubes: How Safe Are They?

Abstract

Purpose: To evaluate the indications, complications and survival of patients undergoing percutaneous endoscopic gastrostomy (PEG) tube placement over a one-year period in a large academic community hospital. Methods: Medical records of all patients undergoing PEG placement from August 2006 through September 2007 were reviewed. Data was collected and entered into a PEG registry. Telephone follow up was made after a 1 year period to determine long term outcome. Results: 281 PEGs were performed during the study period. 52.3% were males with a mean age of 71.5 yrs. The indications for PEG placement were as follows: dysphagia 24.5%, organic brain injury 13.1%, dementia 12%, malignancy 16.3%, long term ventilation 8%, CHF/COPD 9.3%, failure to thrive 8.5%, persistent vegetative state 1.4% and other 5%. 52.3% of PEGs were performed by a gastroenterologist, 19% by a surgeon and 28.7% by a combination of surgeon/gastroenterologist. 57 (20.2%) of the cases had reported complications. Complications were as follows: 17 aspirations, 18 peristomal infections, 6 bleeding episodes, 4 cases of gastroparesis, 3 cases of peritonitis, 3 stomal leakage, 3 interval development of gastric ulcers, 7 cases of inadvertent removal, 2 cases of extra-gastric placement, 3 perforations, and 1 case each of bowel obstruction, acute renal failure and necrotizing fasciitis. 87 (31%) and 67 (23.8%) died within 6 and 6-12 months of PEG placement, respectively. 154 (54.8%) patients died within 12 months of PEG placement. 95 (33.4%) survived greater than 12 months. 32 (11.4%) were lost to follow up. Of the 147 procedures performed by a gastroenterologist, 22 cases had 27 reported complications (15%). Of the 81 procedures done by the combination of a gastroenterologist/surgeon, 27 cases had 34 reported complications (33%). Of the 53 procedures done by surgeons alone, 8 cases had 8 reported complications (15%). No patient died as an immediate result of any complication or immediately following PEG placement. Conclusion: The overall complication rate for PEG placement at our institution was 20.2% with the majority of these complications being mild. The fact that 31% of the patients died within 6 months and 23.8% died between 6 and 12 months following PEG placement suggests that PEG tube placement did not alter the course of the underlying disease or improve long-term outcomes. These results bring into question the appropriateness of patient selection and the indications for PEG placement. PEG placement by a combination of gastroenterologist and surgeon had the highest number and percentage of complications. Further analyses should be performed to determined specific risk factors for predicting poor survival following PEG tube placement.