Percutaneous Endoscopic Gastrostomy in elderly, indications, safety and outcomes
DOI:
https://doi.org/10.22516/25007440.16Keywords:
Elderly, percutaneous endoscopic gastrostomy, complicationsAbstract
Introduction: Percutaneous endoscopic gastrostomies (PEG) are performed more and more frequently in elderly patients suffering from problems with swallowing. The procedure is used regardless of patients’ physical, mental and functional status, but little is known about complications and outcomes here in Colombia. Objective: The purpose of the study is to determine indications for performance of PEG, rate of complications, and outcomes in short and long term follow-ups (five years). Patients and methods: This is a retrospective and descriptive study of patients over the age of 60 who were hospitalized for percutaneous endoscopic gastrostomy at the Clínica Fundadores between January 2008 and June 2013. Patients younger than 60 years of age, those who had open gastrostomies, and those whose PEG procedure failed were excluded. Patients medical records were reviewed and telephone follow-ups of patients were conducted. Results: Of the 135 patients with indications for PEG, 96 patients were included. The mean age was 77.5 ± 9 years, and 38 of the patients were men (39.5%). The reasons for performance of PEG were inability to swallow due to a cerebrovascular event (32.89%), dementia (30.26 %) and other causes (36.85). Hypertension was the most common comorbidity. The most common complications associated with PEG were gastrointestinal symptoms (32.9%). There was no mortality associated with the procedure. Conclusions: PEG is a safe way for elderly patients to receive enteral tube feeding (ETF), but we found no benefit for patients with dementia. Interdisciplinary management prior to the procedure is important to determine whether or not ETF should be used for elderly patients.Downloads
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United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2013.
DANE (Departamento Administrativo Nacional de Estadística). Estimación y proyección nacional, departa- mental y municipal total por área 1985-2020. Disponible en: http//www.dane.gov.co, consultado en enero de 2014.
John BK, Bullock M, Brenner L, McGaw C, Scolapio J. Nutrition in the elderly. Frequently asked question. Am J Gastroenterol 2013;108:1252-66.
Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced demen- tia. N Engl J Med 2009;361:1529-1538.
Gauderer MWL, Ponsky Jl, Izant J. Gastrostomy without laparotomy, a percutaneous technique. J Pedriatr Surg 1980;15:872-5.
Volkert D, Berner YN, Berry E, Cederholm T, Coti BP, Milne A. et al. ESPEN (European Society for Parenteral and Enteral Nutrition). Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr 2006;25:330-60.
Sebastian JJ. Gastrostomía endoscópica percutánea. Técnica e indicaciones. Endocrinol Nutr. 2004;51:158-62.
Pereira JL, Belda O, Parejo J, Serrano P, Bozada JM, Fraile J, et al. La gastrostomía endoscópica percutánea. Realidad en la práctica nutricional clínica intra y extrahospitalaria. Rev Clin Esp 2005;205:472-7.
Razavi F, Gross S, Katz S. Endoscopy in the elderly: Risks, benefits, and yield of common endoscopic procedures. Clin Geriatr Med 2014;30:133-47.
Skelly R. Are we using percutaneous endoscopic gastros- tomy appropriately in the elderly? Curr Opin Clin Nutr Metab Care 2002;5:35-42.
Jones B, Holden C, Dalzell M, Micklewright A, Glencorse C. Annual BANS Report Artificial Nutrition Support in the UK 2005. A Report by the British Artificial Nutrition Survey (BANS), a committee of BAPEN (The British Association for Parenteral and Enteral Nutrition) UK 2005:13-17.
Slater R. Percutaneous endoscopic gastrostomy feeding: Indications and management. Brit J Nur 2009;18:1036-43.
Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database of Systematic Reviews. 2009;2:1-25.
Britton JE, Lipscomb G, Mohr PD, Rees WD, Young AC. The use of percutaneous endoscopic gastrostomy (PEG) feeding tubes in patients with neurological disease. J Neurol 1997;244:431-4.
SaundersJ,BrownMS,HirataRM,JaquesDA.Percutaneous endoscopic gastrostomy in patients with head and neck malignancies. Am J Surg. 1991;162:391-93.
Erdogan A. Single endoscopist-performed percuta- neous endoscopic gastrostomy tube placement. World J Gastroenterol 2013;19:4172-6.
ChicharroL.Complicacionesinmediatasdelagastrostomía percutánea de alimentación: 10 años de experiencia. Nutr Hosp 2009;24:73-6.
Gillick MR. Rethinking the role of tube feeding in patients with advanced dementia. N Engl J Med 2000;342:206-10.
Wanden-Berghe C, Muñoz J, Cantó C, Domenech MD, Reyes MD, Pérez Moya C. Gastrostomía Endoscópica Percutánea (PEG): 10 años de experiencia. Nutr Hosp 2010;25:949-53.
Gundogan K, Yurci A, Coskun R, Baskol R, Gursoy S, Hebbar G, et al. Outcomes of percutaneous endoscopic gastrostomy in hospitalized patients at a tertiary care center in Turkey. Eur J Clin Nutr 2014;68:437-40.
Moreno N, Otero W, Gómez M. Síndrome de “buried bum-
per” (botón interno de la gastrostomía enterrado): desenterrando la solución. Rev Col Gastroenterol 2007;22:51-7.
Cardin F. Special considerations for endoscopists on PEG indications in older patients. ISRN ISRN Gastroenterol 2012;2012:60714.
Peñaloza A, Suárez J, Blanco L, Peñaloza A. Gastrostomía
endoscópica percutánea: ¿Es éticamente aceptable? Rev Col Gastroenterol 2013;28:150-60.
Chang WK, Hsieh TY. Safety of percutaneous endoscopic
gastrostomy in high-risk patients. J Gastroenterol Hepatol 2013;28(Suppl 4):118-22.
Yriberry S, Monge V, Cabrera F, Barriga E, Vesco E.
Gastrostomía endoscópica percutánea: experiencia pros- pectiva de un centro privado nacional. Rev Gastroenterol Perú 2004;24:314-22.
Elia M, Russell CA, Stratton RJ, Shaffer J, Micklewright A, Wood S, et al. Trends in artificial nutritional support in the UK during 1996-2000. A report by the British Artificial Nutrition Survey (BANS). British Association of Parenteral and Enteral Nutrition. Maidenhead, UK: BAPEN 2001.
Mendiratta P, Tilford JM, Prodhan P, Curseen K, Azhar G, Wei JY. Trends in percutaneous endoscopic gastrostomy pla- cement in the elderly from 1993 to 2003. Am J Alzheimers Dis Other Demen 2012;27:609-13.
MalmgrenA,HedeG,KarlströmB,CederholmT,Lundquist P, Wirén M, et al. Indications for percutaneous endosco- pic gastrostomy and survival in old adults. FoodNutr Res 2011;55:6037-42.
McClave SA, Chang WK. Complications of enteral access. Gastrointest. Endosc 2003;58:739-51.
Finocchiaro C, Galleta R, Rovera G, Ferrari A, Todros L, Vuolo A, et al. Percutaneous endoscopic gastrostomy a long term follow-up. Nutrition 1997;13:520-3.
Meine G, Lukashok H, Mello G, Mansur G, Guimarães D, Carvalho R, et al. Buried Bumper Syndrome as a com- plication of percutaneous endoscopic gastrostomy in cancer patients: The brazilian experience. Digest Endosc 2007;19:22-5.
Schrag S, Sharma R, Jaik N, Seamon M, Lukaszczyk J, Martin N, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis 2007;16:407-18.
Warren J, Rohrer J. Frontotemporal dementia. BMJ 2013;347:4827-35.
Ahronheim JC, Mulvihill M, Sieger C, Park P, Fries BE. State practice variations in the use of tube feeding for nur- sing home residents with severe cognitive impairment. J Am Geriatr Soc 2001;49:148-52.
Mitchell SL, Teno JM, Roy J, Kabumoto G, Mor V. Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment. JAMA 2003;290:73-80.
López L, Iñiguez F, Santos E, Balado M, Pérez-Carnero A.
Gastrostomía percutánea endoscópica. Experiencia en un hospital general. Rev Esp Enferm Dig 1994;85:173-6.
Martín A, Espinós J, Forné M, Rius J, Corbera G, Quintana S, et al. Gastrostomía endoscópica percutánea: estudio de
enfermos. Med Clin 1994;103:449-51.
Park R, Allison M, Lang J, Spence E, Morris A, Danesh B, et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992;304:1406-9.
G e n c o s m a n o g l u R , K o c D , To z u n N . P e r c u t a n e o u s endoscopic gastrostomy: results of 115 cases. Hepatogastroenterology 2003;50:886-8.
Kaw M, Sekas G. Long-term follow-up of consequences of percutaneous endoscopic gastrostomy (PEG) tubes in nur- sing home patients. Dig Dis Sci 1994;39:738-43.
Callahan C, Haag K, Weinberger M, Tierney WM, Buchanan NN, Stump TE, et al. Outcomes of percutaneous endosco- pic gastrostomy among older adults in a community setting. J Am Geriatr Soc 2000;48:1048-54.
Mccann R, Hall W, Groth-Juncker A. Comfort care for ter- minally ill patients. The appropriate use of nutrition and hydration. JAMA 1994;272:1263-6.
Candy B, Sampson E, Jones L. Enteral tube feeding in older people with advanced dementia: Findings from a Cochcrane systematic review. Int J Palliative Nurs 2009;55:396-404.
Morgenstern L, Laquer M, Treyzon L. Ethical challenges of percutaneous endoscopic gastrostomy. Surg Endosc 2005;19:398-400.
Sanders D, Carter M, D’Silva J, James G, Bolton R, Bardhan K. Survival analysis in percutaneous endoscopic gastros- tomy feeding: A worse outcome in patients with dementia. Am J Gastroenterol 2000;95:1472-5.
Nair S, Hertan H, Pitchumoni CS. Hypoalbuminemia is a poor predictor of survival after percutaneous endosco- pic gastrostomy in elderly patients with dementia. Am J Gastroenterol 2000;95:133-6.
Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact of survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med 1997;157:327-32.
Murphy LM, Lipman TO. Percutaneous endoscopic gas- trostomy does not prolong survival in patients with demen- tia. Arch Intern Med 2003;163:1351-3.
Dharmarajan TS, Unnikrishnan D, Pitchumoni CS. Percutaneous endoscopic gastrostomy and outcome in dementia. Am J Gastroenterol. 2001;96:2556-2563.
Körner U, Bondolfi A, Bühler E, MacFie J, Meguid M, Messing B, et al. Ethical and legal aspects of enteral nutri- tion. ESPEN guidelines. Clin Nutr 2006;25:196-202.
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