Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy in a prospective cohort study.
ABSTRACT Percutaneous endoscopic gastrostomy (PEG) is a procedure with many complications that sometimes can be devastating. To give better advice to patients referred for PEG regarding risk of complications, important risk factors should be known.
To evaluate whether age, body mass index, albumin levels, C-reactive protein (CRP) levels, indication for PEG, and comorbidity influence the risk of mortality or peristomal infection after PEG insertion.
Prospective cohort study from 2005 to 2009. Follow-up 14 days after PEG.
This study involved 484 patients referred for PEG.
Mortality within 30 days and peristomal infection within 14 days after PEG insertion. All risk estimates were calculated with 95% CIs and adjusted for confounding.
Among 484 patients, 58 (12%) died within 30 days after PEG insertion. Albumin <30 g/L (hazard ratio [HR], 3.46; 95% CI, 1.75-6.88), CRP ≥10 (HR, 3.47; 95% CI, 1.68-7.18), age ≥65 years (HR, 2.26; 95% CI, 1.20-4.25) and possibly body mass index <18.5 (HR, 2.04; 95% CI, 0.97-4.31) were associated with increased mortality. Patients with a combination of low albumin and high CRP levels had a mortality rate of 20.5% compared with 2.6% among patients with normal values, rendering an over 7-fold increased adjusted risk of mortality (HR, 7.45; 95% CI, 2.62-21.19).
Missing data in some study variables. Although the sample size was large, weaker associations could not be established.
The combination of low albumin and high CRP levels indicates a substantially increased short-term mortality risk after PEG, which should be considered in decision making.
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ABSTRACT: Purpose: Percutaneous Endoscopic Gastrostomy (PEG) has been the method of choice to provide enteral access for patients in need of nutrition for a long term. Although considered safe, the insertion of gastrostomy catheters may be associated with some complications. Objectives: The aim of this study was to analyze the immediate, technical and infectious complications of PEG in neurological patients, conducted by a reference team. Methods: We conducted a follow-up of 171 patients who underwent PEG between 2000 and 2011 at the Department of Digestive Surgery (Gastronutri) Hospital São Lucas, Natal / Brazil. Results: Of the 172 cases of PEG, there were 03 deaths until the 30th day after surgery, but none directly related to the procedure. The overall complication rate was 14.6%, among which 8.2% of patients had minor complications and only 6.4% major complications. Patients above 81 years old had lower odds of postoperative pneumonia (p = 0.004). By discriminating the time of use of a nasogastric catheter is greater or less than 06 weeks duration, it was found that the prolonged use is associated with increased incidence of postoperative pneumonia (p<0.05). Finally, if we consider malnutrition as independent correlate, malnourished patients are more likely to develop complications and pneumonia (p<0.05). Conclusion: The complication rates of PEG in our service are consistent with the literature, confirming the efficacy and safety of PEG enteral nutritional support in the neurological patients, however, not free from serious complications.JOURNAL OF SURGICAL AND CLINICAL RESEARCH. 01/2014; 5(1):31-39.
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ABSTRACT: Percutaneous endoscopic gastrostomy (PEG) is a method of providing enteral nutrition using endoscopy. The PEG techniques differ according to the insertion method, and include the pull type, push type, and introducer type. The aim of this study was to compare the clinical outcomes associated with the pull-type and introducer-type PEG insertion techniques, which included the adverse events, at our tertiary care center in Korea. We retrospectively reviewed 141 cases that had undergone PEG insertion at our center from January 2009 to June 2012. The indications for PEG insertion and the acute and chronic complications caused by each type of PEG insertion were analyzed. The indications for PEG insertion in our cohort included neurologic disease (58.7%), malignancy (21.7%), and other indications (19.6%). Successful PEG insertions were performed on 136 cases (96.5%), and there were no PEG-associated deaths. Bleeding was the most frequent acute complication (12.8%), and wound problems were the most frequent chronic complications (8.8%). There were no statistically significant differences between the pull-type and introducer-type PEG insertion techniques in relation to complication rates in our study population. PEG insertion is considered a safe procedure. The pull-type and introducer-type PEG insertion techniques produce comparable outcomes, and physicians may choose either of these approaches according to the circumstances.Clinical endoscopy. 11/2014; 47(6):530-7.
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ABSTRACT: Percutaneous endoscopy gastrostomy (PEG) tubes are a valuable tool for providing long-term enteral nutrition or gastric decompression; certain circumstances that complicate PEG placement warrant novel approaches and merit review and discussion. Ascites and portal hypertension with varices have been associated with poorer outcomes. Bleeding is one of the most common serious complications affecting approximately 2.5% of all procedures. This article will review what evidence exists in these high risk scenarios and attempt to provide more clarity when considering these challenging clinical circumstances.