PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE HOME REPLACEMENT – PROSPECTIVE EVALUATION OF A STANDARDIZED PROTOCOL

Aims:

Percutaneous endoscopic gastrostomy (PEG) are the main route for enteral nutrition (EN) improving patients' survival and QoL. PEG tube exchange management is still debated. Since the introduction of a gastroenterological home-care service in our territory, our Unit drew and adopted a tube exchange protocol. We prospectively evaluated safety and efficacy of this protocol at patient domicile.

Methods:

A prospectively evaluation of all patients who underwent PEG tube exchange was performed; we recorded age, gender, indication for EN, time from PEG placement and last exchange, home visit duration, complications and need for endoscopy, radiology or hospital referral. The protocol was reviewed by local IRB. Tube replacement was planned 6 months after placement or last exchange; the team was composed by a gastroenterologist and a trained nurse. “Sky blue technique” was always adopted to exclude misplacements; EN was restarted the same day. In any case of doubt, the patient was referred to the hospital to complete the procedure or to exclude adverse events.

Results:

From July 2016 to November 2018, 234 tube exchanges have been performed in 99 patients (41 male; median age 83.5 [74 – 98] years). Main indications for EN were dementia (47.5%), stroke (28.3%), coma (15.2%) and neuro-degenerative disorders (9.1%). 31 procedures (13.2%) in 13 patients were urgently performed after tube dislocation and were excluded. Among 203 elective procedures, 197 (97.0%) have been performed at home (procedure time 27 [19 – 47] minutes). Six patients were referred to the hospital; 2 exchanges were routinely performed; one patient with stoma stenosis underwent endoscopic boogie-dilation; 3 patients required x-ray assessment to exclude misplacement. No adverse events were reported.

Conclusions:

Domiciliary tube replacement, following a standardized protocol, is a completely safe technique. The procedure could be performed at patient's home in most cases (> 95%), leading to a significant reduction of costs (> 300 euro/procedure) and burden for patients and caregivers.