S617 Characteristics and Outcomes of Patients Consulted for Percutaneous Endoscopic Gastrostomy Tubes During the COVID-19 Pandemic: A Multicenter Experience

Abstract

Introduction: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, can result in critical illness and an unprecedented burden on the healthcare system. Severe cases can lead to prolonged hospitalizations, intubations and tracheostomy placements necessitating longer term nutrition planning including placement of percutaneous endoscopic gastrostomy (PEG) tubes. However, major uncertainties surround PEG tube placement in patients with COVID-19, including resources, exposure, and most importantly, the natural history of the disease, which we attempt to address through this study. Methods: We retrospectively analyzed all patients seen in consultation for PEG tube placement at two hospitals in New York City, considered an epicenter of the COVID-19 pandemic, between March 20, 2020 and May 15, 2020. Results: We identified 41 consecutive inpatients who were COVID+ and whose primary team consulted gastroenterology for PEG tube placement. The GI service placed PEG tubes in 24 patients (PEG cohort), and deferred placement in 17 others (noPEG cohort). Patients in the PEG cohort had higher Sheffield gastrostomy scores, Charlson comorbidity indices, and NUTRIC scores. Twelve of 41 (29%) of all consulted patients eventually tolerated per os (PO) intake by time of discharge/analysis, involving 53% of the noPEG cohort versus 13% of the PEG cohort (p=0.016). Average time from tracheostomy to PEG placement and from GI consult to PEG placement was 14±9 days and 3±3 days, respectively. PEG-related complications included bleeding (2), dislodgement (1), and colonic perforation (1). Conclusion: As many patients infected with COVID-19 become critically ill and develop prolonged hospitalizations, providing enteral feeding access via PEG tube placement is an increasingly common request. Some patients who were consulted for PEG tube were able to resume PO intake, and there were even requests to remove PEGs that were placed during the same hospitalization. While PEG tubes are generally safe, complications can occur, and careful selection of patients is essential to avoid unnecessary morbidity.Table 1.: Characteristics comparing COVID+ patients who had PEG tube placed by GI (PEG cohort) vs not placed by GI (noPEG cohort) *p = < 0.05 COVID+: positive for SARS-CoV-2 by nasopharyngeal swab; PEG: percutaneous endoscopic gastrostomy; GI: gastroenterology; BMI: body mass index; NUTRIC: nutrition risk in critically ill; SLP: speech-language pathology; NGT: nasogastric tube; OGT: orogastric tube; SNF: skilled nursing facility; PO: per os