Response

Abstract

Thank you for your interest in our study regarding risk factors for complications after the insertion of percutaneous endoscopic gastrostomy (PEG) tubes. We would like to point out that PEG tube insertion is not an acute surgical procedure and therefore, like other elective surgical procedures, should be done in medically optimized patients, after nutritional supplementation and treatment of infections, to reduce the risk of complications. It also should be stressed that there are alternatives to PEG to cover the nutritional needs during any period of such optimization, for example, feeding through a nasogastric tube or intravenous administration.As we have shown in our study on risk factors for complications after PEG, a C-reactive protein level >10 mg/L (normal, <3 mg/L) combined with an albumin level <30 g/L (normal, 36-45 g/L) is a marker of a substantially increased risk of early mortality after PEG tube insertion. A 20% 1-month mortality must be considered a very poor outcome after any elective surgery, including PEG. High C-reactive protein levels combined with low albumin levels could be signs of a patient with acute disease who could be stabilized before the elective surgical procedure. If the patient dies from the underlying disease during an attempt at optimization, the patient is unlikely to have gained anything from a PEG. On the other hand, if the treatment reduces the underlying illness, the PEG tube could be inserted with a decreased risk of mortality. If the patient does not respond to treatment and has stable disease after 3 or 4 weeks, insertion of a PEG tube could be reconsidered.Regarding the question of reanalyzing the risk factors in the different indication groups, we noted that the association between albumin and C-reactive protein levels and risk of mortality was found in all indication groups. Thank you for your interest in our study regarding risk factors for complications after the insertion of percutaneous endoscopic gastrostomy (PEG) tubes. We would like to point out that PEG tube insertion is not an acute surgical procedure and therefore, like other elective surgical procedures, should be done in medically optimized patients, after nutritional supplementation and treatment of infections, to reduce the risk of complications. It also should be stressed that there are alternatives to PEG to cover the nutritional needs during any period of such optimization, for example, feeding through a nasogastric tube or intravenous administration. As we have shown in our study on risk factors for complications after PEG, a C-reactive protein level >10 mg/L (normal, <3 mg/L) combined with an albumin level <30 g/L (normal, 36-45 g/L) is a marker of a substantially increased risk of early mortality after PEG tube insertion. A 20% 1-month mortality must be considered a very poor outcome after any elective surgery, including PEG. High C-reactive protein levels combined with low albumin levels could be signs of a patient with acute disease who could be stabilized before the elective surgical procedure. If the patient dies from the underlying disease during an attempt at optimization, the patient is unlikely to have gained anything from a PEG. On the other hand, if the treatment reduces the underlying illness, the PEG tube could be inserted with a decreased risk of mortality. If the patient does not respond to treatment and has stable disease after 3 or 4 weeks, insertion of a PEG tube could be reconsidered. Regarding the question of reanalyzing the risk factors in the different indication groups, we noted that the association between albumin and C-reactive protein levels and risk of mortality was found in all indication groups. Percutaneous endoscopic gastrostomy tube placement should be done when indicated, regardless of C-reactive protein and albumin levelsGastrointestinal EndoscopyVol. 74Issue 3PreviewWe read with interest the article by Blomberg et al1 on the value of elevated C-reactive protein (CRP) levels and low albumin levels in predicting mortality in patients before percutaneous endoscopic gastrostomy (PEG) tube placement. We do have a few concerns, however, about how the study was conducted and ramifications of its conclusion of a 20% 1-month mortality rate in some patients who undergo PEG tube placement. Full-Text PDF