The effect of increased case volume on percutaneous endoscopic gastrostomy outcomes: A single endoscopist experience

Abstract

Background The technique of percutaneous endoscopic gastrostomy (PEG) is performed at low volumes in many developing countries in the Caribbean. The PEG technique has been in use for eight years at a service hospital in Jamaica and over this time we have noted a progressive increase in case volume. We studied the effect of the increase in case volume on PEG outcomes. Methods We carried out a retrospective audit of all PEG procedures performed by a single endoscopist at this institution from January 1999 to December 2006. The data were divided into two groups for analysis. Group A consisted of patients who had PEG placement within the first four years of its utility. The patients who had PEG placement between January 2003 and December 2006 were placed into group B. Data were compared using Fisher's exact test and Chi square statistics. Results There were 161 PEG tubes placed in 155 patients during the study period with procedure-specific complications in 8.7% of cases. The yearly case volume has doubled for group B (13.8 vs 26.5) and this has been accompanied by a significant fall in PEG-specific morbidity (17.7% vs 4.1%; P = 0.01). There has also been a trend toward increased mortality within group B at seven days (0 vs 4.1%; P = 1.0) and at thirty days (9.8% vs 18.4%; P = 0.465). Conclusions The increase in case volume has contributed to the endoscopist's proficiency with this technique, leading to significant reduction in PEG-related morbidity. We must ensure that endoscopists are provided with adequate supplies, sufficient operating time and dedicated space in order to maintain good outcomes.