Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988

Background and Aims: We previously reported a 30-day mortality following percutaneous endoscopic gastrostomy (PEG) of 8% (1988-92). Concerns over increasing mortality rates prompted us to survey current practice compared with 1988-92: assess case mix, outcome, risk factors for early death, and review practice guidelines. Methods: 78 consecutive adults were referred for PEG over 7 months. Baseline characteristics, including age and functional status (Barthel Index), and outcome at 30 and 180 days were prospectively evaluated. Results: 74 patients. Median age 69 years; male 55%. Major underlying diagnoses: cerebrovascular disease 42%, head and neck tumours 19%, motor neurone disease 4% (33%,16% and 27% in 1988-92). Mortality rates at 30, 90 and 180 days were 19%, 35% and 42% respectively (8%, 20% and 37% in 1988-92). Univariate analysis showed that age > 75 years, Barthel Index <1 and Glasgow Coma Scale less than or equal to10 were significant risk factors for death at 30 days: odds ratios (95% confidence intervals) 3.9 (11-13), 5.9 (1.4-25) and 4.4 (1.2-15) respectively. Conclusions: 30-day mortality was increased from 8% to 19% between 1988-92 and 1998-99 reflecting a change in referral patterns: more elderly with cerebrovascular disease and fewer with motor neurone disease. Age and functional status should be considered when advising on PEG feeding. (C) 2002 Elsevier Science Ltd. All rights reserved.