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Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion

Authors
  • Pih, Gyu Young1
  • Na, Hee Kyong1
  • Ahn, Ji Yong1
  • Jung, Kee Wook1
  • Kim, Do Hoon1
  • Lee, Jeong Hoon1
  • Choi, Kee Don1
  • Song, Ho June1
  • Lee, Gin Hyug1
  • Jung, Hwoon-Yong1
  • 1 University of Ulsan College of Medicine, Department of Gastroenterology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea , Seoul (South Korea)
Type
Published Article
Journal
BMC Gastroenterology
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Jun 28, 2018
Volume
18
Issue
1
Identifiers
DOI: 10.1186/s12876-018-0825-8
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundPercutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure; however, acute and chronic complications of PEG have been reported. We aimed to determine risk factors associated with complications and 30-day mortality after PEG, based on 11 years of experience at a single tertiary hospital.MethodsIn total, 401 patients who underwent first PEG insertion at the Asan Medical Center, Seoul, Korea, between January 2005 and December 2015 were eligible. Medical records were retrospectively reviewed to determine clinical characteristics and outcomes of 139 and 262 patients who underwent pull-type and introducer-type PEG, respectively.ResultsThe median age of the overall population was 68 years, and the median body mass index was 19.5 kg/m2. Acute and chronic complications developed in 96 (23.9%) and 105 (26.2%) patients. Acute ileus and chronic tube obstruction were significantly more frequent in the introducer-type PEG group (p = 0.033 and 0.001, respectively). The 30-day mortality rate was 5.0% (median survival: 10.5 days). Multivariate analysis revealed that underlying malignancy was a predictor of acute complications; age ≥ 70 years and diabetes mellitus were predictors of chronic complications. The median follow-up was 354 days. Neurologic disease and malignancy were the most common indications for PEG. Neurologic diseases were classified into two groups: stroke and the other neurologic disease group (including dementia, Parkinson’s disease, neuromuscular disease, and hypoxic brain damage). Multivariate analysis showed that 30-day mortality was significantly lower in the other neurologic disease group and higher in patients with platelet count < 100,000/μL, and C-reactive protein (CRP) ≥ 5 mg/dL.ConclusionsPEG is a relatively safe and feasible procedure, but it was associated with significantly higher early mortality rate in patients with platelet count < 100,000/μL or CPR≥5mg/dL, and lower early mortality rate in neurologic disease group including dementia, Parkinson's disase, neuromuscular disease, and hypoxic brain damage. In addition, acute complications in patients with underlying malignancy, and chronic complications in patients aged ≥70 and those with diabetes mellitus should be considered during and after PEG.

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