S3448 Percutaneous Endoscopic Gastrostomy Placement in Patients Infected with SARS-CoV-2, A Single Center Review

Abstract

Introduction: Infection with SARS-CoV-2 can manifest with several gastrointestinal symptoms, specifically diarrhea, nausea, vomiting, gastrointestinal bleeding and loss of appetite. In patients requiring hospitalization, especially the critically ill, loss of appetite can quickly cause severe malnutrition, hindering the body’s ability to recover from illness. Severe disease also results in sequelae including prolonged mechanical ventilation and stroke, further limiting enteral nutrition and in many cases, creates a need for percutaneous endoscopic gastrostomy (PEG). We aim to characterize the demographics, timeline and severity of disease of patients with COVID-19 who required PEG placement at our institution. Methods: This was a single-center retrospective cohort study evaluating patients who tested positive for SARS-CoV-2 from March 2020 through January 2021, and had a percutaneous endoscopic gastrostomy (PEG) tube placed as an inpatient. Primary endpoints include the number of patients with COVID-19 requiring PEG, time from COVID-19 diagnosis to PEG placement, and severity of COVID-19 in those requiring PEG (measured by intensive care unit requirements, respiratory status, and medical treatment beyond supportive care). Secondary endpoints include demographics, past medical history of diabetes and stroke, and BMI. Results: 12,224 patients were COVID-19 positive from March 2020 - January 2021. 76 patients underwent inpatient PEG placement. 68/76 patients (89.5%) required ICU admission and 66/76 (86.8%) patients were considered to have severe or critical COVID infection. The average age of patients was 65, 46 were male, and 48.7% of patients were white. On average, PEG placement occurred 26.4 days after positive COVID test. Average BMI on admission was 30.5, serum protein on admission 6.7 and albumin 3.4. One third of patients had a history of DM, where 17% had a history of past or current stroke. Enteral access via nasogastric tube (NGT)/Dobhoff prior to PEG was noted in 71/76 patients. Conclusion: Our data suggests severity of COVID infection is the greatest predictor of patients that will require PEG placement. Nutritional status on admission, comorbidities, and demographic data is unlikely to help determine those that will require enteral access. As COVID-19 cases continue to present and patients recover, Gastroenterologists should be aware of the frequency and population in which PEGs were placed as management and decision for removal may fall in their purview.Figure 1.: Comparison made between those people who were admitted to the intensive care unit and underwent PEG placement and those that did not require the intensive care unit and received PEG placement.