Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan.

Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara-shi, Tochigi 329-2763, Japan.
World Journal of Gastroenterology (Impact Factor: 2.37). 10/2010; 16(40):5084-91.
Source: PubMed


To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan.
We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient's characteristics at PEG using log-rank tests and Cox proportional hazard models.
Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors.
These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors.

Download full-text


Available from: Akira Horiuchi
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Percutaneous endoscopic gastrostomy (PEG) is a proven feeding tube, just as the nasogastric tube is proven to be able to deliver enteral nutrition. For long-term use, both patient and caregiver want neither. What is desired is the LOOPPEG® 3G tube, more secure than the PEG, and less risky to change than the nasogastric tube. Future clinical research should focus on this high-comfort low-risk tube.
    Preview · Article · Jun 2011 · World Journal of Gastroenterology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Today we are faced with an aging society that may develop malnutrition because of dysphagia related to dementia, stroke, and malignancy seen often in the elderly. The preferred form of nutritional supplementation for this group is enteral nutrition, and the most appropriate long-term method is by use of a gastrostomy. Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 as an alternative to the traditional operative procedure and rapidly became the preferred procedure. In geriatric patients, the principal indications are neurological dysphagia and malnutrition, related to an underlying disease or anorexia-cachexia in very elderly. PEG is contraindicated in the presence of respiratory distress, previous gastric resection, total esophageal obstruction, coagulation disorders and sepsis in the elderly. Common complications include wound infection, leakage, hemorrhage, and fistula in the general population, but aspiration pneumonia is the major case of death in this group. Risks and complications of PEG must be discussed with patients and their families; and the decision for percutaneous endoscopic gastrostomy insertion should only be made after careful consideration and discussion between managing physicians, allied health professionals, and the patient and/or family. Four ethical principles may help make feeding decisions: beneficence, non-maleficence, autonomy and justice. Attentive long-term care after tube replacement is mandatory. Acceptance of percutaneous endoscopic gastrostomy placement by patients and their families tends to increase once favorable outcomes are offered.
    Full-text · Article · Sep 2011 · International Journal of Gerontology

  • No preview · Article · Dec 2011 · Endoscopy
Show more