Percutaneous endoscopic gastrostomy: A review of indications, complications and outcome

Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective method of feeding via the stomach in situations where oral intak e is not possible. Its simplicity has led to its potential use in areas of dubious clinical benefit. Our unit has faced a major increase in referrals for PEG insertion over the last 2 years. For this reason we decided to audi t our PEG insertion procedures with regard to indications, complications, o utcome and follow up. We studied 168 patients who had an initial PEG insert ion during the period 1 February 1996-31 January 1998. The medical records of these patients were reviewed with regard to the procedure, antibiotic us e and complications. All patients (or carers or next of kin) were contacted by telephone to provide details regarding late complications and follow up . There were 87 females and 81 males (aged 16-98 years, median age 70 years ). At 2 years, 67% were alive. The most frequent indication for PEG inserti on was a neurological condition, the commonest being stroke. Most patients received either ticarcillin/clavulanic acid or cephazolin antibiotic prophy laxis before and after the procedure. In six patients (3.6%) infection at t he PEG site required intravenous antibiotics. Four of these six patients di d not have antibiotic prophylaxis. Only two deaths could be directly relate d to the procedure. Three died within 7 days of the procedure due to unrela ted medical complications. Sixteen patients died within 1 month, the majori ty of these patients did not leave hospital. One-fifth of the patients (35/ 168) had their PEG removed due to the reestablishment of oral feeding, with median time of use, 4.3 months. It is a safe, effective feeding method in the elderly, but experience with case selection, the procedure and careful follow up remain essential. The use of prophylactic antibiotics resulted in few significant infections of the PEG site. Up to one-fifth of patients wi ll require their PEG only for a short term. (C) 2000 Blackwell Science Asia Pty Ltd.