Utilization of PEG in Diverse Clinical Practice Settings in the United States

Abstract

Utilization of PEG in Diverse Clinical Practice Settings in the United States Adam E. Silverblatt, Leann Michaels, Nora Mattek, Glenn Eisen, David Lieberman Background/Aims: Percutaneous Endoscopic Gastrostomy (PEG) is performed when patients are or will be unable to maintain adequate nutritional intake. Recent events increased attention to artificial nutrition and hydration. Prior research describes single center experiences with PEG and mostly focuses on mortality or quality of life benefits. Our aim is to study PEG utilization in diverse practice settings to determine indications, patient demographics, and success rates. Methods: PEG tubes placed between July 2004 and June 2005 were reviewed from the Clinical Outcomes Research Initiative (CORI), an endoscopic database derived from 73 practice sites in 24 states. EGD reports for PEG insertion in patients over age 17 were included. Indication for PEG was reviewed manually from the CORI database when necessary. Results: 1269 PEG procedures (59% Male) are reported. 409 (32%) procedures were performed in patients over 80 years of age. The majority of patients were white non-hispanic (n Z 882, 69.5%) and received PEGs in community (n Z 770, 60.7%), academic (n Z 255, 20.1%), and VA/military (n Z 244, 19.2%) facilities. Procedures occurred in the hospital (n Z 1207, 95.1%) or in ambulatory endoscopy units (n Z 62, 4.9%) and were done in 595 (46.9%) inpatients and 378 (29.8%) outpatients (unidentified in 296 (23.3%) patients). The majority of patients had severe systemic illness (ASA III or IV) (n Z 622, 49%). Patient demographics and indications are shown in Table 1, with the most common reasons being neurologic conditions (35%) and cancer (16%). Success rate for PEG insertion was 98%. Immediate complications were reported in 35 (2.8%) patients, predominantly oxygen saturation less than 95% (n Z 12). One patient had a serious complication (perforation). Conclusions: This large study describes utilization of PEG in diverse clinical practice settings. The patients are elderly (mean age Z 70.3) and frail (ASA III-IV:57%). Neurologic conditions and cancer (usually ENT) account for almost one-half of procedures. Further study is needed to determine if PEG improves quality of life in these settings.