COMPLICATIONS AND OUTCOME OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN DIFFERENT PATIENT GROUPS

A retrospective study of percutaneous endoscopic gastrostomy (PEG) was performed to evaluate-the complications of PEG and determine the role of prophylactic antibiotics in preventing early wound infection and t o evaluate the outcome of patients in different groups (neurological d isease, head injury, AIDS). Percutaneous endoscopic gastrostomy was pe rformed on 50 patients between March 1991 and November 1993 and the su rvey was completed in July 1994. The average time to PEG placement pos t-cerebrovascular accident or head injury was 5 weeks. No deaths were attributable to the procedure. Four of 50 (8%) patients died in the fi rst 30 days (early mortality). Wound infection (early eight, late five ) was the most-common complication: two of 13 patients receiving proph ylactic antibiotics and six of 37 not receiving antibiotics had early wound infection. At completion of followup 19 of 26 patients with neur ological disease had died (median survival = 370 days), three resumed oral feeding and four continued PEG feeding. All head injury patients (n = 6) were alive and had resumed oral feeding; five returned home. A ll AIDS patients (n = 7) died within 12 months (median survival = 138 days), although improved nutritional state was found after gastrostomy feeding. In conclusion, PEG placement is a useful procedure to assist feeding in multiple patient groups. Wound infection is a common but n ot life threatening complication. The need for prophylactic antibiotic s to prevent early wound infection has not been proven. The 5 week del ay in PEG insertion may contribute to lower early mortality. The 100% survival rate in head injury patients may reflect their young age and absence of underlying medical illness. In AIDS patients, improved nutr itional state is not known to translate into better quality of life or prolonged survival.