PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN A GENERAL-HOSPITAL - PROSPECTIVE EVALUATION OF INDICATIONS, OUTCOME, AND RANDOMIZED COMPARISON OF 2 TUBE DESIGNS

The indications for percutaneous endoscopic gastrostomy (PEG) and pati ent outcome, were examined prospectively in the setting of a general h ospital. In the course of 26 months, 76 patients underwent PEG (median age 62 years (range 18-99)) and were followed up for 6887 patient day s. The median (range) duration of PEG feeding was 93 (3-785) days. The procedure was carried out for neurological indications in 76% of case s (stroke 51%) and 53% of patients were severely malnourished (body ma ss index < 17 kg/m(2)) at the time of referral. In 12 (16%) patients s wallowing recovered and the PEG was removed after a median (range) of 55 days (20-150). Three (4%) deaths were related to PEG (one oesophage al perforation, one haemorrhage, and one aspiration pneumonia). One pa tient developed peritonism and ileus, which resolved with conservative treatment. Minor complications included local sepsis 3%, tube blockag e 12%, and tube connector leak 5%. During seven days of observation, d emands on nursing time for routine care of the PEG were the same as fo r nasogastric tube feeding, median (range) 21 (4-42) v 16 (4-40) min/d ay respectively, but in about half the latter cases the tube had to be replaced at least once. Over 15 months, 29 patients were randomised t o receive a 1.9 mm inner, 2.9 mm (9F) outer diameter Fresenius and 27 a 3.0 mm inner, 4.0 mm (12F) outer diameter Bower polyurethane tube an d were followed for 2920 and 2388 patient days respectively. There was no difference in the insertion time (median (range) 20 (10-45) v 24 ( 10-45) min respectively) or number of patients with complications (thr ee v eight patients NS), although there were more minor mechanical pro blems (three v 12, p<0.01) with the 12F tube. The internal anchoring d evice of the 12F tube allowed its non-endoscopic removal, a method app licable to 16% of cases. No tubes were removed because of blockage.