Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) feeding has been valid ated in specific clinical situations such as acute stroke with dysphagia an d oropharyngeal malignancy. The perception that gastrostomy insertion is sa fe and technically simple has led to an increase in the demands for PEG ins ertion, encompassing clinical applications such as in patients with dementi a. in whom its role has not been justified. The purpose of this study was t o compare the mortality of patients with dementia who were fed by PEG to th at of other subgroups of patients requiring gastrostomy feeding. METHODS: The study focused on a cohort of 361 consecutive patients requirin g PEG feeding between August 1992 and July 1997 from two District General H ospitals (Rotherham District General Hospital and Doncaster Royal Infirmary ) in South Yorkshire. A retrospective cohort survival analysis was performe d using the Kaplan-Meier survival method and Cox proportional hazards analy sis. RESULTS: In all patients requiring gastrostomy feeding there is a high init ial mortality of 28% at 30 days. However, patients with dementia have a wor se prognosis compared to other subgroups, with 54% having died at 1 month a nd 90% at 1 yr (log rank test p < 0.0001). This difference remained signifi cant (log rank p < 0.0001) after adjusting for age at the time of PEG inser tion. CONCLUSIONS: This is the first demonstration in the United Kingdom that the mortality of patients with dementia who are fed by gastrostomy is consider able. Consequently, we may wish to advise against gastrostomy feeding in se lected patients within this clinical setting. (Am J Gastroenterol 2000;95:1 472-1475. (C) 2000 by Am. Coll. of Gastroenterology).