Percutaneous Endoscopic Gastrostomy In Patients Research Articles

The outcomes of long term home enteral nutrition (HEN) in older patients with severe dementia

European and international guidelines advice against initiating tube-feeding in patients with severe dementia. These recommendations are based on studies with important methodological limitations that evaluated the benefits of artificial nutrition in patients with percutaneous endoscopic gastrostomy almost exclusively in terms of the prolongation of survival. The aims of this study were to assess the harmful effects of home enteral nutrition administered via the nasogastric tube and percutaneous endoscopic gastrostomy in patients with advanced dementia in terms of mechanical, gastrointestinal and metabolic complications, to estimate the survival, to explore the risk factors for mortality and to compare the outcomes of patients with advanced dementia with those of patients without dementia. The retrospective observational study was carried out on 585 consecutive patients of the mean age of 85.6±6.9 years. They were treated using home enteral nutrition from 2010 to 2015 according to follow-up protocols adopted by the Clinical Nutrition Unit of an Italian geriatric research hospital (IRCCS-INRCA, Ancona). Incidence rates of mechanical, gastrointestinal and metabolic complications and survival rates in patients with severe dementia were compared to those in patients without dementia. The Cox proportional hazards model was used to evaluate the mortality risk factors. There was no difference between the incidence rates of complications in patients with severe dementia and those in patients without dementia. The incidence of mechanical complications was 1.35/1000 days for patients without dementia vs. 1.53/1000 days for patients with dementia (p=0.270), the incidence of gastrointestinal complications was 1.30/1000 days for patients without dementia vs. 1.35/1000 days for patients with dementia (p=0.984) and the incidence of metabolic complications was 0.36/1000 days for patients without dementia vs. 0.35/1000 days for patients with dementia (p=0.252). The Kaplan Mailer analyses showed that there was no evidence to support the theses on poorer prognosis of survival of patients with dementia (median survival was 193 days for patients without dementia vs. 192 days for patients with dementia, (p>0.05)). The female gender, advanced age, nasogastric tube, diabetes mellitus and chronic renal failure were identified as risk factors. Subjects whose Geriatric Nutritional Risk Index values were higher had a lower risk of mortality. The discussion on the appropriateness of enteral nutrition in patients with severe dementia is still open. Our results show that, if there is a medical prescription for tube-feeding and a patient's surrogate decision-makers express free and informed consent to the tube-feeding of the patient, enteral nutrition should not be contraindicated a priori if the patient has severe dementia. Regular follow-up is mandatory to guarantee adherence to the therapy and achieve its initial aims and to ensure that the principles of beneficence and nonmaleficence are respected.

Trends and Outcomes of Early Versus Late Percutaneous Endoscopic Gastrostomy Placement in Patients With Traumatic Brain Injury: Nationwide Population-based Study

Oral intake for traumatic brain injury (TBI) patients is often not an option because of facial trauma, swallowing dysfunctions, altered consciousness, etc. These patients often require percutaneous endoscopic gastrostomy (PEG) placement for nutrition support. To date, there is lack of studies examining the relationship between the timing of PEG placement and patient outcome in the TBI group. We conducted a population-based study in a retrospective cohort of TBI patients undergoing PEG, using the national inpatient sample for years 2011 to 2013. A total of 96,625 patients were identified for TBI and 3343 of those patients received PEG. TBI patients who undergo an early or late PEG placement had a higher rate of in-hospital mortality, when compared with patients with a standard timing of PEG placement. Late PEG was preferably placed in patients with higher Charlson index and trauma-related comorbidities, and these patients had a higher incidence of complications, that is, sepsis, urinary tract infection, acute respiratory distress syndrome/pneumonia, and deep vein thrombosis/pulmonary embolism. When stratified by mortality-risk groups, early PEG was associated with higher rates of in-hospital mortality while standard PEG was associated with best mortality outcomes in low-mortality-risk group and moderate-mortality-risk group. The results of this study suggest that if a PEG placement is indicated for a TBI patient, a standard (7 to 14 d) timing may be associated with better patient outcomes. However, secondary to limitations associated with the use of administrative databases, further prospective studies are needed to establish clear guidelines regarding the optimal timing of placing PEG in TBI patients.

Prognostic nutritional index and early mortality with percutaneous endoscopic gastrostomy.

Although percutaneous endoscopic gastrostomy (PEG) is a well-accepted and less invasive method of feeding tube placement in patients with swallowing difficulties, complications and early death after PEG have been reported. This study aimed to evaluate predictive factors associated with 30-day mortality after PEG, and to assess the utility of nutritional supporting period before PEG in reducing early mortality following PEG. An observational study. We retrospectively analyzed 268 patients who underwent PEG at Sapporo Shirakaba-dai Hospital from 2006 to 2010, using clinical and laboratory data to analyze predictive factors associated with early death after PEG. Then, we prospectively assessed 152 consecutive patients assessed for eligibility for PEG from 2011 to 2014. We assessed the patients' nutritional condition using Onodera's prognostic nutritional index (PNI), and supported nutrition for more than 10 days before PEG in patients with a poor nutritional index (PNI < 37). In both univariate and multivariate analyses in the retrospective study, Onodera's PNI of less than 37 was the only predictive factor for early mortality. In the second study, among the 115 patients who finally underwent PEG, early mortality rates improved to 1.7% from 5.2% in the first study. Conversely, 32% of patients with malnutrition who did not undergo PEG died within 30 days. Nutritional status might be a predictive factor for early mortality after PEG. In patients with poor nutritional status, nutritional supporting period before PEG might improve the outcomes and reduce unnecessary PEG.

Attitudes of radiation oncologists to percutaneous endoscopic gastrostomy in patients with head and neck cancer and eating difficulties: A survey in China.

ObjectiveTo investigate the attitudes of radiation oncologists towards using percutaneous endoscopic gastrostomy (PEG) to solve nutritional problems in patients with head and neck cancer (HNC) undergoing radiotherapy.MethodsA self-reported questionnaire was developed and used to assess the willingness of radiation oncologists from 26 hospitals throughout several provinces in China to use the nutritional method.ResultsOf the 433 radiation oncologists who were contacted and returned questionnaires, 361 were completed correctly and used in the study (83.4% completion rate). Years of working and degree of understanding PEG were significantly related to the willingness of oncologists to use PEG in patients with HNC. Radiation oncologists who were willing to accept PEG training were more willing to use PEG. Main reasons for unwillingness to use PEG were poor understanding of the operation or cost and fear of side effects causing medical disputes.ConclusionsThe findings of the survey suggest that attitudes of radiation oncologists in China towards using PEG in patients with HNC requiring nutritional support may be improved by providing accessible training in the technique.

Usage characteristics and adverse event rates ​of the direct puncture and pull techniques for percutaneous endoscopic gastrostomy in patients with malignant tumors of the upper aerodigestive tract

Background and study aims Patients with malignant tumors of the upper gastrointestinal tract are at risk of weight loss. Early supportive nutrition therapy is therefore recommended and usually requires placement of a percutaneous endoscopic gastrostomy (PEG). The aim of this study was to compare adverse events and usage characteristics of the direct puncture technique with those of the traditional pull technique when used in patients with endoscopically passable tumors. The primary endpoint was the rate of inflammatory adverse events (AEs) at the gastrostomy fistula. The secondary endpoint was the long-term rate of puncture-site metastases. Patients and methods One hundred twenty patients (median age 56; IQR 36, 86 years) were randomized and treated per protocol in this prospective open randomized single-center study. Follow-ups were conducted on the third and seventh post-interventional days, after 1, 3 and 6 months and the last follow-up 5 years after intervention. Results Within the short-term follow-up period of 6 months after PEG placement, AEs were noted in 47 patients (39.2 %). These included 22 inflammations and 16 device dislocations and were mainly found in the puncture group (33 vs. 14 in the pull group) with a significantly increased incidence in the first month after PEG insertion ( P = 0.001). Evaluation of the 5-year data did not reveal any significant differences. The gastrostomy tube was used in 101 patients (84.2 %) (range 18 days to 5 years). Conclusions Our results favor the pull technique for patients with endoscopically passable tumors of the upper gastrointestinal tract due to less short-term adverse events. Both systems contributed equally to secure long-term use.

Percutaneous endoscopic gastrostomy for patients requiring for long-term enteral nutrition: A retrospective study of 84 patients

Background and Aims: Existed studies about Percutaneous Endoscopic Gastrostomy (PEG) were mainly aimed at certain patient populations and data came from China are quite limited. Our aim was to investigate whether PEG in South China is effective and to compare the indications and complications of PEG with those reported in the literature. Materials and Methods: Patients underwent PEG procedure during the period from January 2000 to October 2014 in Nanfang Hospital were retrospectively collected and analysed. The patients’ lymphocyte counts, leukocyte counts, serum albumin, hemoglobin, serum total protein, weight and BMI before and after PEG operation were reviewed as the main outcome measurement. Indications, complications and success rates of PEG procedure were also evaluated. Results: A total of 84 patients (61 males, 23 females) were enrolled, with an average age of 55.01 ± 15.16 y (range 3.0-92 y). The overall success rate is about 98.8%. The most common indication for PEG in South China is head and neck cancer (27/84, 32.1%). Significant differences were observed in parameters such as lymphocyte counts, serum albumin, serum total protein, body weight, BMI before and after PEG operation.(1.29 vs. 1.76, p=0.005; 33.58 vs. 33.66, p=0.012; 62.82 vs. 67.29, p=0.018; 43.62 vs. 48.29, p=0.044; 16.24 vs. 18, p=0.030; respectively). The most common procedure-related complication was PEG tube removal (6/84, 7.14%), which were all well managed. Conclusions: This is the first retrospective case series evaluating PEG procedure in South China. Our results indicate that PEG is an effective and safe method for long-term enteral nutrition.

Outcomes of percutaneous endoscopic gastrostomy: One surgeon experience

Aim: We aimed to present our experience and findings in patients which in we applied percutaneous endoscopic gastrostomy (PEG) tube insertion because of the oral nutritional deficiency. Material andMethods: The data of 41 patients who had PEG tube insertion between 2014 and 2018 years in the General Surgery Clinic of Medicine Faculty of Ordu University were evaluated retrospectively. The indications, complications, mortality and short-term outcomes of the patients were analyzed. Results: 43 patients underwent gastroscopy due to insertion of PEG. In 41(95.3%) patients, PEG insertion was successful. In 2(4.7%) patients, peg insertion failed due to obesity. 16(39%) of the PEG patients were males and 25 (61%) were females. The mean age was 77.68 ± 13.9 (20-94) years. PEG indications were chronic neurological disease in 22 (53.6%) patients, cerebrovascular disease in 15 (36.6%) patients and malignancy in 4 (9.8%) patients. Minor complications in 11(26.8%) patients and major complications in 2 (4.9%) patients were observed. 10 (24.4%) of the complications were in the early period and 3 (7.3%) were in the late period. During the follow up, the PEG tube in 3 (7.3%) patients was pull out. No mortality due to PEG insertion was observed. During the mean follow-up period of 9.37 ± 7.8 months, 14 (34.1%) of the PEG-treated patients died due to their primary disease. Conclusions: PEG tube insertion is an easy method with the low rates of the complication and mortality in the patients with poor oral intake who have a functional gastrointestinal system. PEG is the first choice for long-term enteral nutrition in appropriate patients.

Percutaneous endoscopic gastrostomy in patients with duchenne muscular dystrophy compare with amyotrophic lateral sclerosis: a retrospective study

Percutaneous endoscopic gastrostomy in patients with duchenne muscular dystrophy compare with amyotrophic lateral sclerosis: a retrospective study

P.11 - Percutaneous endoscopic gastrostomy in patients with Duchenne muscular dystrophy compared with amyotrophic lateral sclerosis and Parkinson syndrome

P.11 - Percutaneous endoscopic gastrostomy in patients with Duchenne muscular dystrophy compared with amyotrophic lateral sclerosis and Parkinson syndrome

Non‐ketotic hyperosmolar coma after percutaneous endoscopic gastrostomy in an advanced stage of progressive supranuclear palsy

AbstractPatients with progressive supranuclear palsy often suffer from dysphagia, and percutaneous endoscopic gastrostomy is a treatment option for the advanced stage of this disease. The present percutaneous endoscopic gastrostomy patient had slightly impaired glucose tolerance, but the condition became considerably worse with normal nutrients due to limited activity and an infection after percutaneous endoscopic gastrostomy, resulting in a non‐ketotic hyperosmolar coma. After receiving supplementary fluid, intravenous insulin, antibiotics and endotracheal intubation, the patient recovered from the non‐ketotic hyperosmolar coma state. Percutaneous endoscopic gastrostomy placement at an advanced stage of a neurodegenerative disorder, such as progressive supranuclear palsy, should have a careful follow‐up, especially when glucose tolerance worsens.

Percutaneous Endoscopic Gastrostomy in Patients with Acute Neurologic Injury (P3.040)

Percutaneous Endoscopic Gastrostomy in Patients with Acute Neurologic Injury (P3.040)

Increasing Serum Albumin Level Shortly After Gastrostomy Tube Insertion Predicts Longer Survival in Elderly Patients With Dementia.

To identify factors influencing survival after percutaneous endoscopic gastrostomy (PEG) tube insertion in elderly patients with severe dementia. Use of PEG in patients with dementia raises medical and ethical questions. The cohort included 189 patients aged ≥64 years with severe dementia who underwent PEG tube insertion in 2002 to 2011 at a tertiary hospital and were followed through 2014. Data were collected on background diseases, laboratory tests conducted 14 (±10) days before and 90 (±10) days after PEG, and date of death. Multivariate Cox regression analysis was performed and cumulative survival curves plotted. Mean baseline serum albumin level was significantly lower in patients who died ≤30 days after PEG (n=32, 16.9%) than patients who survived longer (2.9±0.5 vs. 3.3±0.5 g/dL, P<0.001), and significantly higher in patients who survived 1 year after PEG (n=96, 50.8%) than patients who died earlier (3.4±0.5 vs. 3.1±0.5 g/dL, P=0.002). No significant differences were found for the other laboratory parameters. After adjustment for background diseases, serum albumin level above the median (3.3 g/dL) was the only predictor of survival (hazard ratio 0.51; 95% confidence interval, 0.37-0.72; P<0.001). Patients with stable/increased serum albumin levels at 90 days after PEG (n=80, 42.3%) survived longer than patients with decreased levels. The only predictor of survival after adjustment for age and background diseases was a stable/increased albumin level at 90 days (hazard ratio 0.59; 95% confidence interval, 0.42-0.85; P=0.004). Survival after PEG tube insertion is associated with a higher serum albumin level at baseline and a stable/increased serum albumin level during follow-up.

Efficiency analysis on percutaneous endoscopic gastrostomy for patients with persistent dysphagia after stroke

Objective To observe the effects of percutaneous endoscopic gastrostomy (PEG)on mortality and complications in patients with persistent dysphagia after stroke using a points-scoring system for selecting PEG indication. Methods A total of 75 patients were divided into low score group without PEG, high score group without PEG and low score group with PEG (n=25 each). The follow-up period was 18 months, and the differences in complications, mortalities and survival periods among groups were compared. Results The number of times of aspiration pneumonia was (1.36±1.44) in low score group, (1.96±2.28) in high score group, (0.36±0.64) in low score group with PEG, with statistically significant differences among three groups (H=7.148, P=0.028). No difference in the morbidity of aspiration pneumonia was found between low score group and high score group (P=0.189). The number of times of aspiration pneumonia was decreased in low score groups after PEG versus in low score group without PEG (P=0.030) and in high score group (P<0.01). The number of times of gastrointestinal hemorrhage was (0.48±0.77)in low score group, (0.64±0.91) in high score group, (0.12±0.33) in low score group with PEG, with statistically significant differences among three groups (H=5.532, P=0.063). No statistically significant difference in gastrointestinal hemorrhage was found between low score groups and low score group after PEG (P=0.430), as well as between low score group and low score group with PEG (P=0.079). The morbidity of gastrointestinal hemorrhage was lower in low score group than in high score group (P=0.012). The survival rate at the observation end was 88.0% (22/25), 52.0% (13/25) and 92.0% (23/25) in low score group, high score group and low score group with PEG, respectively, with statistically significant difference among the three groups (χ2=7.906, P=0.001). Kaplan-Meier survival curve showed that the survival period were longer in the low score group with or without PEG than in high score group (P<0.01) , but no statistically significant difference was found between low score groups with or without PEG (P=0.626). Conclusions The reasonable evaluation using a points-scoring system before PEG might predict the prognosis of such patients: the higher score would indicate higher mortality. PEG operation for low score group with better condition could decrease the aspiration pneumonia and decrease gastrointestinal hemorrhage significantly, but could not prolong general survival time and decrease general mortality. Key words: Stroke; Deglutition disorders; Gastrostomy

Percutaneous endoscopic gastrostomy in patients with ALS at the Ljubljana ALS Centre – a retrospective analysis

Percutaneous endoscopic gastrostomy in patients with ALS at the Ljubljana ALS Centre – a retrospective analysis

Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG)

Background and study aims: Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia may result in prolonged hospitalization and postoperative mortality. This study evaluated the efficacy of using semi-solid feeds to reduce feeding-related adverse events and improve clinical outcomes. Patients and methods: Patients who received PEG for enteral nutrition at our hospital between January 2014 and December 2015 were allocated to a postoperative feeding protocol that used either liquid feed or semi-solid feed. Baseline characteristics, postoperative feeding-related adverse events and clinical outcomes in the 2 groups were prospectively analysed and compared. Results: One hundred and seventeen PEG patients (age range: 59 – 97 years, male: 53) were enrolled with 72 patients given liquid feed and 45 patients receiving semi-solid feed. Baseline characteristics were similar in both groups. The semi-solid feed group experienced fewer incidence of feeding-related aspiration pneumonia (2.2 % vs. 22.2 %, P < 0.005) and shorter postoperative hospital length of stay (12.7 days vs. 18.8 days, P < 0.01). Significant differences were not observed in the frequency of peristomal infection (11.1 % vs. 12.5 %, P = 0.82), feeding-related diarrhea (2.2 % vs. 12.5 %, P = 0.09) and 30-day mortality rates (2.2 % vs. 8.3 %, P = 0.25). Conclusions: Semi-solid feeding may reduce the risk of aspiration pneumonia and shorten postoperative hospital length of stay after PEG. Semi-solid feeds are safe to use and can be employed either as a first line feeding protocol or an alternative when liquid feeding is unsuccessful.

Benefit of percutaneous endoscopic gastrostomy in patients undergoing definitive chemoradiotherapy for locally advanced nasopharyngeal carcinoma.

Background and aimTo evaluate the impact of percutaneous endoscopic gastrostomy (PEG) tube on nutritional status, treatment-related toxicity, and treatment tolerance in patients with locally advanced nasopharyngeal carcinoma (NPC) who underwent chemoradiotherapy.Patients and methodsWe enrolled 133 consecutive non-metastatic NPC (III/IV stage) patients, who were treated with prophylactic PEG feeding before the initiation of concurrent chemoradiotherapy (CCRT) between June 1, 2010 and June 30, 2014. Meanwhile, another 133 non-PEG patients, who were matched for age, gender, and tumor, node, metastases stage, were selected as historical control cohort. Weight and nutritional status changes from pre-radiotherapy to the end of radiotherapy were evaluated, and treatment tolerance and related acute toxicities were analyzed as well.ResultsWe found that significantly more patients (91.73%) in the PEG group could finish two cycles of CCRT, when compared with those in the non-PEG group (57.89%) (P<0.001). We also indicated that more patients (50.38%) in the non-PEG group experienced weight loss of ≥5%, while the phenomenon was only found in 36.09% patients in the PEG group (P=0.019). In addition, the percentage of patients who lost ≥10% of their weight was similar in these two groups. Changes in albumin and prealbumin levels during radiotherapy in the non-PEG group were higher than those obtained for the PEG group with significant differences (P-values of 0.023 and <0.001, respectively). Furthermore, patients in the PEG group had significantly lower incidence of grade III acute mucositis than those in the non-PEG group (22.56% vs 36.84%, P=0.011). Tube-related complications occurred only in 14 (10.53%) patients in the PEG group, including incision infection of various degrees.ConclusionPEG and intensive nutrition support may help to minimize body weight loss, maintain nutritional status, and offer better treatment tolerance for patients with locally advanced NPC who underwent CCRT.

Percutaneous Endoscopic Gastrostomy Tube Insertion in Neurodegenerative Disease: A Retrospective Study and Literature Review

Background/AimsWith the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome.MethodsA retrospective case note review of patients referred for PEG insertion by neurologists in a single neuroscience center was conducted according to a pre-determined set of standards. For the literature review, we identified references from searches of PubMed, mainly with the search items “percutaneous endoscopic gastrostomy” and “neurology” or “neurodegenerative disease.”ResultsShort-term mortality and morbidity associated with PEG in patients with neurological disease were significant. Age greater than 75 years was associated with poor outcome, and a trend toward adverse outcome was observed in patients with low serum albumin. ConclusionsThis study highlights the relatively high risk of PEG in patients with neurodegenerative disease. We present points for consideration to improve outcome in this particularly vulnerable group of patients.

Prevalence of Tracheotomy and Percutaneous Endoscopic Gastrostomy in Patients with Guillain-Barré Syndrome.

Some patients with Guillain-Barré syndrome require respiratory management by tracheotomy and/or nutritional management by tube feeding; however, few studies have reported the follow-up course in these patients. The objective of this study was to investigate the follow-up course of tracheotomy and gastrostomy in patients with Guillain-Barré syndrome. The study subjects were 50 patients with Guillain-Barré syndrome (25 males, 25 females; mean age, 51.1±18.7years) who were admitted to the Hiroshima City Rehabilitation Hospital during the period from April 2008 to December 2015. We retrospectively reviewed the medical records to determine the presence or absence of tracheotomy and/or feeding tube, and the timing of withdrawal from these treatments. During the acute phase, 15 patients underwent tracheotomy and 14 underwent tube feeding management. A tracheotomy tube was inserted for 110days or longer in five patients, and four of these five patients also had a gastrostomy tube inserted. Among the 14 patients in the tube feeding group, seven underwent nasal feeding and seven underwent percutaneous endoscopic gastrostomy. All patients had the nasal tube removed (mean duration of nasal tube placement, 62.1±46.5days); however, the gastrostomy tube could not be removed in two patients. Our findings indicate that patients in the acute phase of Guillain-Barré syndrome carry a relevant risk of long-term tube feeding and prolonged need of an artificial airway.

PTU-099 A Large Prospective Audit of Morbidity and Mortality in Patients with Feeding Gastrostomies Placed for Head and Neck Cancer: Abstract PTU-099 Table 1

Introduction Feeding patients undergoing radical treatment for head and neck cancer via a percutaneous endoscopically or radiologically placed/inserted gastrostomy (PEG, RIG) is common practice. PEG/RIG insertion is not entirely safe and complications may occur with long-term usage. We did a prospective audit of PEG/RIG related complications in patients having them placed prior to surgery for head and neck cancer. Methods Community dietitians reviewed all patients with a gastrostomy placed prior to surgery or radiotherapy for head and neck cancer. They prospectively recorded morbidity and mortality between 2008–2014. In addition hospital databases and case notes were examined. Recorded morbidity included insertion site infection, leakage, over granulation, haemorrhage and buried bumper. Results In the 206 patients there was one death within 30 days from placement, no deaths attributable to gastrostomy placement. One patient underwent a laparotomy for peritonitis. 95 minor complications occurred in 72 (35%) patients or 1:887 days of having a gastrostomy. The commonest complication was peristomal site infection occurring in 55 (27%) patients or 1:1531 days of having a gastrostomy, all of which settled with antibiotics. There was no buried bumpers or tumour implantation at the insertion site reported in the study. There was no procedure related 30 day mortality. Conclusion We have shown a low rate of major complications (0.5%) and a relatively high minor complications rate (35%) of PEGs and RIGs in patients with head and neck cancer. Wound infection can be reduced by careful sterile technique, preoperative antibiotics, a 1 cm abdominal incision and avoiding tightness of the crossbar. We conclude that the use of PEG tubes is a safe method of delivering non-oral nutritional support for patients undergoing treatment for head and neck cancer. References 1 Gauderer MW, Ponsky JL, Izant RJ, Jr. Gastrostomy without laparotomy: A percutaneous endoscopic technique. J Pediatr Surg 1980; 15 :872–5. 2 Mansoor H, Masood MA, Yusuf MA. Complications of percutaneous endoscopic gastrostomy Tube insertion in Cancer patients: A retrospective study. J Gastrintest Cane 2014; 45 :452–459. 3 Burney RE, Bryner BS. Safety and long-term outcomes of percutaneous endoscopic gastrostomy in patients with head and neck cancer. Surg Endosc 2015; 29 (12):3685–9. 4 Hunter JG, Lauretano L, Shellito PC. Percutaneous endoscopic gastrostomy in head and neck Cancer patients. Ann Surg 1989; 210 :42–46. Disclosure of Interest None Declared

Trends regarding percutaneous endoscopic gastrostomy: A nationwide population-based study from 1997 to 2010.

Percutaneous endoscopic gastrostomy (PEG) is widely used in patients requiring long-term tube feeding. Traditional PEG studies usually focused on practical, technical, and ethical issues. There have been little epidemiological studies on PEG utilization and services in Asia. We evaluated the changes in PEG utilization, patient selection, patient characteristics, and medical service in Taiwan from 1997 to 2010.This retrospective study analyzed the data of patients admitted for PEG tube placement according to the International Classification of Diseases, Ninth Revision (procedure code 43.11) extracted from the National Health Insurance database between 1997 and 2010.From 1997 to 2010, the incidence of PEG increased from 0.1 to 3.8/105 population and incidence of PEG among aged patients increased from 0.9 to 19.0/105 population. Compared 1997–2004 to 2005–2010 periods, the percentage of cerebrovascular diseases decreased and esophageal cancer increased in the later period. PEG was mainly performed in male patients and at medical centers. Medical costs, Charlson Comorbidity Index (CCI) scores, and post-PEG mortality rates were higher in the 2005–2010 period than in the 1997–2004 period.PEG procedures are being increasingly performed in Taiwan, and changes in patient selection were noted. The seriousness of accompanying diseases, medical costs, and post-PEG mortality rates in patients undergoing PEG has increased. The present findings may help in the implementation of PEG, relocation of medical resources, and improvement of PEG-related care.