Percutaneous Endoscopic Gastrostomy in Elderly Patients (original) (raw)
Related papers
Survival After Percutaneous Endoscopic Gastrostomy Placement in Older Persons
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2000
Background. The prolongation of life is an important consideration in the decision to initiate long-term tube feeding. This report critically synthesizes the evidence regarding the impact of percutaneous endoscopic gastrostomy (PEG) tube placement on survival in older persons. Methods. A systematic search was conducted using MEDLINE from January 1980 until January 1999. Articles reporting survival data in older persons (mean or median age Ͼ 65 years) after PEG tube placement were identified. The number and age of subjects, length of follow-up, setting, and survival data were extracted from all eligible studies. Mortality data at 1, 2, 6, and 12 months after PEG placement were quantitatively synthesized. Clinical characteristics associated with decreased survival among subjects with PEG tubes were identified. Results. Five cohort studies compared survival in patients with and without feeding tubes in nursing homes, but none demonstrated a survival benefit. Another cohort study reported increased survival for tube-fed patients with amyotrophic lateral sclerosis. The pooled proportion of all subjects surviving after PEG placement was as follows: 1 month ϭ 0.81 (95% confidence interval [CI], 0.74-0.88), 2 months ϭ 0.70 (95% CI, 0.65-0.74), 6 months ϭ 0.56 (95% CI, 0.20-0.92), and 12 months ϭ 0.38 (95% CI, 0.26-0.49). Advanced age and malignancy were the factors most often reported to be associated with poorer survival among subjects with PEG tubes. Conclusions. The impact of PEG placement on survival is not known because the level of evidence is limited. PEG tubes may prolong life in selected populations. However, the majority of older patients selected for PEG placement will not survive 1 year after the procedure. Certain factors may identify those patients more likely to derive a survival benefit from long-term tube feeding. This information may offer some guidance to decision makers for whom prolongation of life is an important factor in the tube-feeding decision.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2019
Percutaneous endoscopic gastrostomy (PEG) is an established practice for long-term nutrition in dysphagia-suffering stroke patients. This study sought to determine the feasibility and safety of outpatient, unsedated PEG implementation in stroke patients. This retrospective cohort study involved stroke victims who underwent unsedated outpatient PEG insertion from 2014 to 2017 at our Surgical Endoscopy Unit. Patients were given pharyngeal anesthesia with lidocaine 10% spray, while the PEG tube was placed under local anesthesia. The incidence of intraprocedural and postprocedural complications and 30-day mortality rate were recorded. Data from 127 cases were analyzed. The procedures were performed with minor, transient complications, which resolved after rescue maneuvers. No intraprocedural and postprocedural major complications or death were observed. During the 30-day follow-up, the most important complication involved a single case of accidental PEG removal that was successfully res...
Haseki Tıp Bülteni, 2021
Aim: Percutaneous endoscopic gastrostomy (PEG) is a method that can be applied for nutritional purposes in patients who cannot be fed orally for various reasons but whose gastrointestinal system functions are normal. In this study, we aimed to determine the etiological causes and long-term outcomes (efficacy, safety, lifespan) of PEG in patients over 65 years of age. Methods: The data of patients aged 65 years or older who had PEG in our unit between 2015 and 2019 were analyzed retrospectively. The demographic information of the patients, the units they are being followed in, the underlying diseases, additional diseases, if any, complications-related to the procedure and the average life span were evaluated. Results: During this period, 140 patients had been PEG inserted. 51% of patients were male and the average age was 73.7±9.2 years, and the average age of women was 76±7.2 years. The most frequent cause of PEG insertion is a neurological disease. PEG insertion was the most common in cerebrovascular events, with a rate of 39%. PEG was implanted in 30% for Alzheimer's disease, and 14% for malignant reasons. 28% of the patients lived less than a month. In total, 76% of patients died. The average life expectancy of patients who died after PEG was 221.3±330.7 days. Conclusion: PEG is the gold standard in patients with normal gastrointestinal system functions in long-term enteral nutrition. However, in patients with a life expectancy of less than 1 month, the decision to place PEG or not should be made carefully.
Asia Pacific journal of clinical nutrition, 2021
BACKGROUND AND OBJECTIVES Percutaneous endoscopic gastrostomy (PEG) has been widely used since 1980 in enteral feeding of patients that are not able to be fed orally for a long time. The aim of this study is to evaluate the PEG indications, effectiveness and PEG related complications from a single center in Istanbul, Turkey. METHODS AND STUDY DESIGN 265 patients with PEG who were followed up by the clinical nutrition team of a university hospital between 2010-2018 were evaluated retrospectively. Nutritional Risk Screening-2002 (NRS-2002) test, anthropometric measurements, bioelectrical impedance analysis and laboratory data were used to evaluate the patients' nutritional status. RESULTS The most common indications for PEG were dementia (35.1%), amyotrophic lateral sclerosis (22.6%), stroke (15.8%), and cancer (14%). The mean body weight of the patients was increased after PEG (63.5±12.2 vs 62.0±12.7 kg). Mid upper arm circumference and calf circumference of the patients increase...
Percutaneous endoscopic gastrostomy: Indications, limitations, techniques, and results
World Journal of Surgery, 1989
Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method for nutritional support in patients with malnutrition and impossibility of oral intake with an estimated survival higher than the months that require enteral nutrition beyond four weeks. The main indications include neoplasms of the upper air-digestive tract and neurological diseases, with dementia currently considered a controversial indication. Anatomical alterations and infectious diseases are the most frequent contraindications. There are different endoscopic techniques; the most widely used being the "pull" method, with a low mortality. Complications are more frequent in patients with multiple pathologies and the elderly. Wound infection, extraction of the tube, tube blockage and bronchoaspiratory pneumonia are the most prevalent complications. Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of these.
Predicting outcomes and complications of percutaneous endoscopic gastrostomy
Endoscopy, 2007
Introduction ! Obtaining enteral access has become the founda− tion of aggressive nutritional support. Since it was first described in 1980, percutaneous endo− scopic gastrostomy (PEG) has been the preferred route for long−term enteral feeding of patients whose gastrointestinal tract is functionally intact but who are unable to maintain sufficient oral in− take as a result of a variety of medical conditions [1 ± 3]. The most common indication is inade− quate swallowing because of a neurological event or secondary to oropharyngeal cancer. We can also use PEG for gastric decompression or nutri− tional supplementation in patients who are un− dergoing radiotherapy or chemotherapy. A num− ber of advantages have been claimed for PEG in comparison with nasogastric or orogastric tubes, such as greater comfort, less frequent displace− ment, greater improvement in nutritional status, and a better cosmetic appearance . Feeding via PEG should be the preferred method if the pa− tient's nutritional intake is likely to be inade− quate for a period exceeding 2 ± 4 weeks [1, 3]. PEG placement is considered to be an easy proce− dure, with a success rate of more than 95 % [4]. However, there have been very few prospective studies evaluating the outcomes of PEG [5 ± 8]. Kobayashi et al.