Time Of Percutaneous Endoscopic Gastrostomy Placement Research Articles

Complications of one-step button percutaneous endoscopic gastrostomy in children.

To assess the complications of one-step button percutaneous endoscopic gastrostomy (B-PEG) and determine risk factors for developing stomal infections or gastropexy complications. A retrospective study of 679 children who underwent a B-PEG procedure in a single tertiary care center over a 10-year period to December 2020 was conducted. Patient characteristics, early complications (occurring ≤ 7days after the procedure), late complications (> 7days after the procedure), and outcomes were collected from medical records. A list of potential risk factors, including age at procedure, prematurity, underlying neurological disease, and undernutrition, was determined a priori. At least 1year of follow-up was available for 513 patients. Median follow-up duration was 2.8years (interquartile range 1.0-4.9years). Major complications were rare (< 2%), and no death was related to B-PEG. Early complications affected 15.9% of the study population, and 78.0% of children presented late complications. Development of granulation tissue was the most common complication followed in frequency by tube dislodgment and T-fastener complications. Only 24 patients (3.5%) presented stomal infections. Young age at the time of PEG placement (odds ratio (OR) 2.34 [1.03-5.30], p = .042) was a risk factor for developing peristomal infection. T-fastener migration occurred in 17.3% of children, and we found underlying neurological disease was a protective factor (OR 0.59 [0.37-0.92], p = .019). Conclusion: B-PEG is a safe method and associated with a low rate of local infection. However, T-fasteners are associated with significant morbidity and require particular attention in young and premature infants. What is Known: • Percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide long-term enteral nutrition in children to prevent malnutrition. The Pull-PEG method is still the most commonly used with complications , such as stomal infection. Since its description, only a few studies have reported postoperative complications of one-step button PEG (B-PEG). What is New: • T-fastener complications were not rare, and underlying neurologic disease was a protective factor. A very low rate of stomal infection was described, and young age at the time of PEG placement was a risk factor. The B-PEG is a safe method with fewer major complications than P-PEG in children.

Transabdominal ultrasonography for confirmation of accurate percutaneous endoscopic gastrostomy tube placement: analysis of patient- and procedure-related complications

Technique-related factors, patient-related factors, and localization determine the risk for complications in percutaneous endoscopic gastrostomy (PEG) tube placement. The objective of this study was to identify patient characteristics and ultrasonographic parameters after PEG tube placement concerning localization, which correlate with complications. Patients undergoing PEG-tube placement were examined by abdominal ultrasound after dismissal from the endoscopic recovery room. Patient demographics, PEG characteristics, ultrasonographic parameters and complications were retrospectively analyzed. Of 64 enrolled patients, 59.4% were male and the mean age was 62.3 years. A significant negative correlation between complications at PEG placement and Body-Mass-Index (BMI; kg/m2) was observed (Spearman's Rho: -0.382; p=0.002). A low BMI <18 tended to be more frequent in the group with complication-related PEG removal compared to patients without (18.2% vs. 1.9%). Further descriptive analysis revealed that 4 patients (36.4% of N=11) with and 5 patients (9.4% of N=53) without PEG removal due to complications already had complications at the time of PEG placement. Of the patients with complications during follow-up, those with a peritoneal course (N=10) in ultrasound tended to have a lower BMI (mean ± standard deviation: 22.5±6.5 vs. 26.8±5.9) compared to those without (N=5). In all 4 patients with a triad of follow-up complications, peritoneal course, and complications at PEG placement, the tube was removed due to complications. Post-PEG-placement ultrasonography can help to determine complications in specific procedure-related conditions. A low BMI was found to be a relevant predictor of PEG-related complications, substantiating the need for early intervention in potentially PEG-relevant indications.

Effectiveness and Complication Rate of Percutaneous Endoscopic Gastrostomy Placement in Pediatric Oncology Patients.

PurposeMalnutrition is a significant issue for pediatric patients with cancer. We sought to evaluate the effectiveness and complication rate of percutaneous endoscopic gastrostomy (PEG) placement in pediatric oncology patients.MethodsA retrospective chart review was performed on 49 pediatric oncology patients undergoing PEG placement at Johns Hopkins All Children's Hospital between 2000 and 2016. Demographic and clinical characteristics, complications, absolute neutrophil count at time of PEG placement and at time of complications, length of stay, and mortality were identified. Weight-for-age Z-scores were evaluated at time of- and six months post-PEG placement.ResultsThe overall mean weight-for-age Z-score improved by 0.73 (p<0.0001) from pre- (–1.11) to post- (–0.38) PEG placement. Improvement in Z-score was seen in patients who were malnourished at time of PEG placement (1.14, p<0.0001), but not in those who were not malnourished (0.32, p=0.197). Site infections were seen in 12 (24%), buried bumper syndrome in five (10%), and tube dislodgement in one (2%) patient. One patient (2%) with fever was treated for possible peritonitis. There were no cases of other major complications, including gastric perforation, gastrocolic fistula, clinically significant bleeding, or PEG-related death documented.ConclusionConsistent with previous studies, our data suggests a relationship between site complications (superficial wound infection, buried bumper syndrome) and neutropenia. Additionally, PEG placement appears to be an effective modality for improving nutritional status in malnourished pediatric oncology patients. However, larger prospective studies with appropriate controls and adjustment for potential confounders are warranted to confirm these findings.

Percutaneous endoscopic gastrostomy: A prospective study

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure for establishing enteral access for nutrition. There is a paucity of literature on PEG from the Indian subcontinent. With the rate of complications in the literature showing a downward trend, we aimed to analyze the same in our institute following a standard procedure of PEG tube placement. Methods: The prospective study was conducted including patients referred for PEG placement from August 2017 to December 2019. Data were recorded on a proforma. The primary aim of the study was to determine the rate of complications in patients undergoing PEG, whereas the secondary aim was to determine whether early feeding was associated with increased rate of infection or other complications. Patients were reviewed after 3 days, 1 month, and every 3 months thereafter later with clinical examination. Results: Sixty-seven (83.75%) males and 13 (16.25%) females with a median age of 51 years (range 1–85) were included in the study. Forty-one (51.25%) patients had comorbidities with hypertension being the most common (n = 28). Postoperative placement of the PEG tube was done in 47 (58.75%) patients. Seventy-four patients had underlying neurological or neurosurgical conditions. At the time of PEG placement, 59 (73.75%) had tracheostomy. All procedures were performed in the endoscopic suite, of which two were performed as day care procedures. There were no intraprocedural complications. Feed was started within 2 h in 45 (56.25%) patients and all tolerated feed well. There were no major postprocedural complications. Thirteen patients had clinically suspected PEG site infection, of which 11 patients had a culture-positive organism. All responded to conservative management. Thirty-two patients were on follow-up at a median follow-up period of 2 years. Conclusion: The incidence of complications following PEG tube placement is low. With the standardization of the PEG technique, no major complications were seen in our study. Early PEG feeding was not associated with an increase in the rate of complications.

Influence of Percutaneous Endoscopic Gastrostomy on Gastroesophageal Reflux Disease in Children

To determine if gastroesophageal reflux disease (GERD) is present at long-term follow-up after percutaneous endoscopic gastrostomy (PEG), and to identify factors associated with the occurrence or aggravation of GERD after PEG placement. This prospective, observational study was conducted in our single tertiary center over a 13-year period (gastrostomy performed from 1990 to 2003 and follow-up to 2015). Every child who underwent PEG in our center (N = 368) from 1990 to 2003 was eligible. GERD was defined by clinical manifestations requiring antisecretory or prokinetic treatment, occurrence of a GERD-related complication, or the need for antireflux surgery. Outcomes among patients without antireflux surgery were also assessed. Multivariate analysis was used to identify factors aggravating GERD after PEG placement. A total 326 patients (89%; 56% with a neurologic impairment) were studied with a median follow-up after 3.5 years (range, 2.0-13.5 years). After PEG placement, GERD appeared in 11% of patients and was aggravated in 25% of patients with preexisting GERD. Factors associated with GERD worsening after PEG placement were neurologic impairment and preexisting GERD. Only 53 patients (16%) required antireflux surgery, among whom 22 required surgery in the year after PEG. Neurologic impairment was the only factor significantly associated with the need for antireflux surgery. GERD predominantly remains clinically controlled after PEG placement. Routine antireflux surgery at the time of PEG placement is not justified.

Percutaneous endoscopic gastrostomy, body weight loss and survival in amyotrophic lateral sclerosis: a population-based registry study

Objective: To assess the role of percutaneous endoscopic gastrostomy (PEG) insertion, and its timing, on ALS survival, and to study prognostic factors of survival before and after PEG placement in a population-based setting.Methods: In this observational population-based, registry study, we enrolled patients with newly- diagnosed ALS, according to the El Escorial revised criteria, who were resident in the Emilia Romagna Region, and who developed severe dysphagia needing enteral nutritional support. The primary outcome measure was tracheostomy-free survival after PEG recommendation.Results: There were 210 patients needing PEG, out of an incident cohort of 545 patients from the Emilia Romagna Registry for ALS, who were diagnosed between 2009 and 2013. One hundred and ninety-three patients were included in the study, and 17 were excluded because they were already tracheostomized at the time of PEG placement. Of the 193 patients included in the study, 152 underwent PEG, whereas 41 did not undergo the procedure. Patients who did not undergo PEG, among the eligible ones, had the same tracheostomy-free survival from onset as patients who did (25 vs. 32 months, p = 0.21). Tracheostomy-free survival from PEG recommendation was greater in patients who underwent PEG placement than in patients who did not (6 vs. 2 months, p = 0.008). Median tracheostomy-free survival from PEG insertion was eight months (95% CI5–12); 30 days after PEG placement, survival was 89.60%. At Cox multivariable analysis, the hazard of death or tracheostomy after PEG insertion was significantly influenced by the difference between BMI at the time of the PEG procedure and BMI at diagnosis (HR 1.05, 95% CI 1.02–1.08; p = 0.002). The hazard of death or tracheostomy was not affected by the timing of PEG insertion.Conclusions: The present study, although it has some limitations, suggests a gain of tracheostomy-free survival from the time of PEG recommendation for patients who undergo PEG placement, and, among patients who undergo PEG, a greater survival if PEG is inserted before a significant weight loss occurs, and if nutritional support avoids further weight loss. Should this association between prevention of weight loss and better clinical outcome be confirmed by further studies, it would have important implications for disease management.

Can technique used for gastrostomy tube placement reduce the risk of gastrostomy-site metastasis in head and neck cancer patients?

Can technique used for gastrostomy tube placement reduce the risk of gastrostomy-site metastasis in head and neck cancer patients?

Long‐Term Outcome of Children Receiving Percutaneous Endoscopic Gastrostomy Feeding

The aim of the present study was to analyze the long-term follow-up of children receiving percutaneous endoscopic gastrostomy (PEG) in terms of survival, nutritional outcome, and weaning from enteral nutrition. The secondary objectives were to evaluate the complications related to PEG and the outcome of patients with neurological disability. The present study was a single-center retrospective study including all of the 368 patients who underwent PEG from 1990 to 2003 in our tertiary hospital. A total of 368 patients received PEG during the study period. After a median follow-up of 2.4 years (interquartile range 1.4-4.2 years), PEG was in place in 36% and was removed in 27%; 26% of patients were deceased. Two deaths could be directly related to PEG. A statistically significant weight and height catch-up was observed in patients with PEG in place in whom weight/age z score increased from -2.6 to -1.7 (P < 0.01) and height/age z score also increased from -2.1 to -1.6 (P < 0.01). In patients who had their PEG removed weight/age z score increased from -2.5 to -1.6 (P < 0.01) and height/age z score from -2.8 to -1.4 (P = 0.01) at the time of weaning. Early complications occurred in 152 patients, whereas late complications occurred in 191 patients. Most complications were minor (85%). After multivariate analyses, the factors associated with late complications were digestive and ear, nose, and throat (ENT) diseases, age <1 year at the time of PEG placement, and use of PEG longer than 2 years. Early complications were less frequent in patients with respiratory diseases. PEG allows nutritional and growth catch-up and is safe in the long term.

Abstract T P245: Time to Percutaneous Endoscopic Gastrostomy (PEG) Placement and National Institutes of Health Stroke Scale (NIHSS) Correlations in Acute Ischemic Stroke (AIS)

Purpose: American Heart Association 2013 guidelines for AIS management emphasize the use of PEG feeding for patients who cannot take solids/liquids orally and a 2-3 week preference for NG after stroke onset. Recent studies suggest 14-28 days before a PEG is placed. Concerns about shortened time-intervals between AIS and PEG placement have arisen, possibly averting rehabilitation of a patient capacity to swallow. High NIHSS scores may be predictive of a patient need for PEG placement. The pilot study was to investigate PEG placement timing and correlation of the NIHSS in patients admitted with AIS in a 5-campus hospital system. Methods: Adult patients (18-99yrs) with AIS ICD-9 primary discharge codes, correlated with PEG placement procedural codes, and NIHSS scores Sept 2012 to Jun 2013. All patients were determined unable to safely swallow, requiring enteral feeding prior to discharge. Patients with chronic dysphagia, previous PEG, traumatic brain injury, intracranial/subarachnoid hemorrhage were excluded. Retrospective chart audit of 56 cases initially identified, 22 final AIS patients had PEG placement for dysphagia prior to hospital discharge with NIHSS documentation. Results: Final cohort statistics: 7 females (32%) and 15 males (68%); mean patient age 78.9 years, median of 78.5 years. Mean number of days between acute onset/admission and PEG placement 12.1 days, median of 7.0 days. Mean admission NIHSS scale was 16.6 points, median 17.5 points. Mean NIHSS score at PEG placement was 19.5 points, median 21 points. 16 patients (72.7%) with NIHSS of 14 points or greater, a score previously correlated with poor long-term rehabilitation outcomes. Comparison of admission NIHSS to NIHSS at the time of PEG placement, 13 patients (59%) had an equal or increased score. Conclusions: Significantly shorter PEG interval times than currently recommended were noted, with high NIHSS. Current rationales are not well understood. Further research is needed to insure ‘allow for swallow’ recovery in the dysphagic AIS patient while mitigating risk of malnutrition and aspiration.

Percutaneous Endoscopic Gastrostomy Tubes in Pediatric Bone Marrow Transplant Patients

Nourishing a child undergoing bone marrow transplant (BMT) is essential, but the optimal method to achieve this is not established. The objectives of the study were to investigate the incidence and risk factors for complications of gastrostomy tubes in patients with BMT. A retrospective chart review was conducted of pediatric patients who received a percutaneous endoscopic gastrostomy (PEG) either for BMT or for other indications during a 3-year period. Occurrences of complications, absolute neutrophil count (ANC) at time of PEG placement, and ANC at time of complication were reviewed for both BMT and the comparison group. Of the 11 subjects in the BMT group, 4 (36%) had a major complication of infection related to PEG and 3 of those required PEG removal. Two of the 4 subjects who developed a major complication were moderately neutropenic at the time of PEG placement and all subjects were neutropenic at the time of complication. Of the 30 subjects in the comparison group, only 1 (2.8%) had a major complication with cellulitis. There were no statistically significant differences between the 2 groups before PEG placement for age, weight, albumin, or white blood cell count. The incidence of complication in BMT compared with the comparison group was significant (P=0.01). Our findings support that ANC should be considered before placement of PEG, significant neutropenia may be a contraindication for PEG placement in BMT patients, and other modalities for nutrition support might need to be considered.

Early Insertion of Percutaneous Endoscopic Gastrostomy in Patients with Isolated Elevated White Blood Cell Counts

Purpose: Percutaneous Endoscopic Gastrostomy (PEG) is a common procedure for patients with dysphagia. Several large prospective trials for PEG have evaluated the efficacy of the procedure. Traditionally gastroenterologists have been hesitant to perform PEG insertions in patients with elevated white blood cell (wbc) counts. Literature review shows that very few published studies have analyzed the complications of PEG placement in otherwise non infected patients with isolated elevated WBC counts. The aim of our study was to analyze complications of PEG placement in patients with isolated elevated WBC counts as compared to patients with normalized wbc counts at the time of PEG placement. Methods: This was a retrospective cohort analysis of a total of 465 patients, 60 men and 405 women who underwent PEG placement. All patients who underwent PEG placement in IMC and NYMH from January 2005 to June 2010 were included in the study. The patients were followed up for a period of one year following PEG placement. Patients with fever, hematological malignancies or on steroids were excluded. A cut off value of 11,000/ml WBCs or above was considered elevated in the study. Patients in group 1 had elevated WBC counts at PEG insertion and patients in group 2 had normal WBC counts. All patients in this study were free from active infections at the time of surgery. This was supported by clinical, laboratory, microbiological and radiologic data obtained from chart review. All patients received preoperative antibiotics as short-term prophylaxis. The data was analyzed using IBM SPSS 20.0. The comparisons between the groups were made using student's t test, Chi-square test and ANOVA. Results: There was significant reduction of 5.19 days in the length of hospital stay with early insertion of PEG (p 0.03). There was no statistically significant increased risk of complications with early insertion of PEG in the presence of isolated elevated WBC counts. There were no cases of severe complications including necrotizing fasciitis, esophageal perforation, colocutaneous fistula, peritonitis, ileus, gastric outlet obstruction or death secondary to PEG placement in either group. Conclusion: In our study, there was no evidence of increased complications or mortality related to early PEG placement in patients with isolated elevated WBC counts. Therefore it is reasonable to consider early PEG placement in patients with isolated elevated wbc counts rather than delaying the PEG procedure for WBC counts to normalize. In our study, early insertion of PEG led to reduction in the average length of hospital stay by 5.19 days (p 0.03). This can lead to substantial reduction in health care costs. Further prospective studies are needed to confirm our findings.Table: Results of PEG placement in isolated elevated wbc counts vs normalized wbc counts

What is the relevance of percutaneous endoscopic gastrostomy on the survival of patients with amyotrophic lateral sclerosis?

Percutaneous endoscopic gastrostomy (PEG) is a standard procedure for feeding dysphagic amyotrophic lateral sclerosis (ALS) patients. Nevertheless, the effect of prognostic factors influencing survival after PEG remains unclear. We aimed to evaluate the prognostic value of several clinical features on survival after PEG placement. This study investigated 151 patients with ALS, in whom a PEG was inserted over the last 16 years in our centre. Survival curves were determined by Kaplan-Meier and the analysis of potential prognostic factors was performed by a Cox regression model. The overall median survival was 32 months, longer in spinal-onset disease patients - 42 vs. 29 months in bulbar-onset patients (p < 0.001). Median survival after PEG placement was 7.5 months, similar in both bulbar- and spinal-onset patients, 7.9 vs. 7.1 months, respectively. Thirteen percent of patients died within one month after PEG placement; this short-term survival was influenced by low forced vital capacity (FVC < 50%). In a multivariate analysis, only older age at disease onset was independently associated with poor outcome after PEG placement. In conclusion, survival after PEG placement was similar in bulbar- and spinal-onset patients, suggesting that the latter were in a more advanced stage at the time of PEG placement. Low FVC was associated with higher risk of short-term mortality. Older age at disease onset was associated with poorer outcome in bulbar-onset patients. Younger bulbar-onset patients are those who benefited most from PEG.

Percutaneous endoscopic gastrostomy (PEG) with T-fasteners obviates the need for emergent replacement after early tube dislodgement

Despite technical refinements of percutaneous endoscopic gastrostomy (PEG) tube placement, complications such as early tube dislodgement remain relatively static. This study aimed to review the experience of a high-volume endoscopy center after the introduction of T-fastener placement in high-risk patients. The authors retrospectively reviewed PEG placement from October 2010 to September 2011, when their group began to use T-fasteners selectively in high-risk patients. Patients deemed to have an increased risk for early tube dislodgement underwent T-fastener placement at the time of PEG placement. Patients with PEG alone were compared with patients who had PEG with T-fastener (PEG-T) placement. Statistical analysis was performed using SPSS version 18. During the study period, 195 patients underwent PEG placement. For 121 patients, PEG alone was performed, whereas PEG-T was performed for 74 patients. Six patients had tube dislodgement (five early, one late) in the PEG-T cohort versus none in the PEG-alone cohort (P = 0.003). The first patient underwent diagnostic laparoscopy with replacement gastrostomy 2 days after tube dislodgement and was noted to have no contamination, with direct apposition of the stomach to the abdominal wall from the T-fasteners. The subsequent four patients with early tube dislodgement underwent non-emergent PEG replacement in the endoscopy unit within 24 h after tube dislodgement. In the short-term follow-up period, no repeat dislodgements were noted. Early mortality in the entire cohort was experienced by 38 (19.5%) of the 195 patients. Placement of T-fasteners in high-risk patients may decrease overall morbidity if early tube dislodgement occurs. The findings show the safety of non-emergent endoscopic replacement of PEGs in certain patients. Early tube dislodgement may be a marker of overall mortality.

Safety of Percutaneous Endoscopic Gastrostomy in Medically Complicated Infants

Percutaneous endoscopic gastrostomy (PEG) tubes have been placed in children for more than 2 decades to provide nutrition to those unable to adequately and safely feed orally. Despite the well-documented success of PEG placement in older children, there is only 1 published article documenting the safety of PEG placement in small infants. In all children, PEG studies demonstrate the major complication rate to vary from 0.5% to 17%. The objective of this study was to evaluate the incidence of acute complications of PEG placement in medically complicated infants with a weight of less than 6 kg. : We reviewed the charts of all infants cared for in the neonatal intensive care unit of Wheaton Franciscan Health Care-St Joseph's Regional Hospital, Milwaukee, WI, who received a PEG tube between January 2001 and June 30, 2008. Forty infants with a mean gestational age of 29 weeks (range 23-41 weeks) with a mean weight of 3250 g (range 2100-5600 g) at time of PEG placement were included. The primary indication for most infants was dysphagia or inability to orally feed safely. A PEG was successfully placed in 38 of 40 (95%) infants. There was 1 major complication: a 38-week infant with Prader-Willi syndrome developed a pneumomediastinum caused by a tear at the upper esophageal sphincter. In a second infant the PEG bumper could not be passed beyond the upper esophageal sphincter. Sixteen infants had other surgical procedures performed at the time of PEG placement. For those infants only having a PEG placed, the mean procedure time was 10 minutes. PEG placement is both feasible and safe in small, medically complicated infants.

Gastro-oesophageal reflux in children with cerebral palsy after percutaneous endoscopic gastrostomy: Any predictors?

Background and study aims Gastro-oesophageal reflux (GER) is common in children with cerebral palsy (CP). Such children often require percutaneous endoscopic gastrostomy (PEG) to alleviate feeding difficulty, yet GER may get worse following PEG. The aim of this study was to assess whether abnormal pH study and oesophagitis or delayed gastric emptying can predict worsening of GER after PEG. Patients and methods A chart review was conducted of 25 children with cerebral palsy (CP) who had PEG performed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between September 2001 and May 2007. Data collected included pre-procedure 24-h pH study, gastric emptying nuclear scan, and histopathology of the oesophageal biopsy obtained at the time of PEG placement. Clinical symptoms of GER and the need for fundoplication were also recorded. Results Twenty-five patients with severe CP (21 male; mean age 6.0 ± 5.3 years) were included. Thirteen (52%) had abnormal pH study. Six (24%) had delayed gastric emptying, and 10 (40%) had histological oesophagitis. Following PEG, 16 (64%) had persistent vomiting. Twelve were controlled with medical treatment. Four (16%) required fundoplication. There was no relation between abnormal pH study, delayed gastric emptying or oesophagitis and the development of persistent vomiting after PEG. There was no statistically significant difference between patients who required fundoplication and the remaining patients in either pH or gastric emptying study. Conclusion An abnormal pH study and oesophagitis or the presence of delayed gastric emptying before PEG placement in children with CP did not predict worsening of GER or the need for fundoplication after PEG.

PEG Placement

Purpose: Gastrostomy tubes are justified for patients who need tube feeding for more than 30 days. The impact of PEG (percutaneous endoscopic gastrostomy) tube placement on patient's survival depends on the patient's underlying conditions. In this study, we analyzed whether h/o recent sepsis (present within 2 weeks before PEG placement), h/o diabetes mellitus or decubitii were negatively associated with patient's early survival at 8 weeks post-PEG. Methods: In this retrospective study, all patients who had PEG placed from 08/2001 to 10/2003 at Interfaith Medical Center Brooklyn NY, were included. Patient's demographics, presence of sepsis (within 2 weeks before PEG), h/o DM or decubitii (stage 2 or greater); and survival at 8 weeks post-PEG were noted. None of the patients were septic at the time of PEG placement. Sepsis was defined by considering together clinical (fever), biochemical (white cell count, urinalysis, culture results) and radiological criteria (chest or abdominal x-rays, CT scan). The data was analyzed using logistic regression model. The results were adjusted for age and gender. Results: There were 125 patients (71% females, 29% males). The average age at the time of PEG placement was 81.3 years (range 45 to 100 years). 36 out of 125 patients (28.8%) expired by 8 weeks. Of those 36 patients, 32 had h/o recent sepsis (88.8%). Using logistic regression analysis, h/o diabetes and decubitii were not found to have statistically significant negative effect on early survival. While h/o recent sepsis was shown to have a statistically significant negative association with early survival (p-value less than 0.0001, odd ratio 12.4 and confidence interval of 3.9 to 39.7). Conclusions: Any history of recent sepsis (within 2 weeks before PEG placement) is negatively associated with early survival at 8 weeks post-PEG. This should be taken into consideration when deciding to place a PEG.

Gastrostomy insertion in ALS patients with low vital capacity: respiratory support and survival.

The authors evaluated their uncontrolled, retrospective experience with 33 patients with ALS with erect or supine forced vital capacity less than 50% predicted who underwent attempted percutaneous endoscopic gastrostomy (PEG) tube placement using noninvasive positive pressure ventilation and oxygen support and conscious sedation anesthesia. Gastrostomy tubes were successfully placed in all patients. Mean survival was 211 days with most patients (67%) surviving more than 180 days. Forced vital capacity at the time of PEG placement did not predict survival.