Percutaneous endoscopic gastrostomy: High mortality rates in hospitalized patients

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) is a widely used metho d for insertion of a gastrostomy tube in patients who are unable to eat but have a normally functioning gut. Complications have been described, especi ally in fragile, debilitated patients, and 30-day mortality rates of 4.1-26 % have been reported. We assessed the outcome of PEG tube placement for inp atients and outpatients, based on morbidity, mortality, and long-term survi val. METHODS: We reviewed the medical records of all patients who underwent PEG at our institution between January 1, 1995 and December 31, 1996. Four grou ps of patients were compared: Group 1, patients from nursing homes; Group 2 , hospitalized patients; Group 3, hospitalized patients matched to Group 2 for diseases, except mental disorder, and not treated with PEG; and Group 4 , the general hospital population matched for age. RESULTS: A total of 114 PEG tubes were inserted in 114 patients, 47 from Gr oup 1, 67 from Group 2. Eighty-seven percent of patients in Group 1 underwe nt PEG because of demential versus 46% of Group 2 (p < 0.001). The mortalit y rate was five times higher in Group 2 than in Group 3 (p < 0.001). The 30 -day mortality was seven times higher in Group 2 than in Group 1, twice tha t in Group 3, and five times higher than in Group 4 (p = 0.002 and p < 0.00 1, respectively). When intention-to-treat analyses were applied to the data , 19/48 patients died (39.5%) in Group 1, and 60/83 (72.0%) died in Group 2 , (p < 0.001). CONCLUSIONS: Patients hospitalized with acute illness are at high risk for serious adverse events after PEG insertion and this procedure should be avo ided.