Percutaneous Endoscopic Gastrostomy: Lessons to learn from a District General Hospital Experience

Aims: To audit mortality and morbidity after PEG and identify high-risk groups for referral guidelines for PEG.

Methods: Patients who had PEG between 2000 and 2002 in a DGH were studied retrospectively. Data was retrieved from Endoscribe ^®, referral forms and case notes. Mortality and morbidity data was noted from patient case notes and death certificates. Statistical analysis performed with multivariate logistic regression using SPSS ^®.

Results: 162 patients underwent PEG with an overall 30-day mortality of 35%. Patients with recent CVA (<4 weeks), age>70 and ASA≥3 correlates with mortality independently (p<0.05). 22% patients developed MRSA wound infection while 18% developed aspiration pneumonia. One patient died from sedation. There were no procedure-related deaths. No formal assessment of existing co-morbid conditions was performed before referral.

Conclusions: PEG is a simple invasive procedure, which is commonly performed in a DGH. There is considerable morbidity associated with the procedure with a significant percentage of mortality among patients who had PEG. High mortality in our study was probably due to inappropriate referrals.

High-risk groups identified for mortality: Age>70 years, ASA≥3 and recent CVA. Careful selection of patients for PEG would maximize the utilization of this service.