Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988

Background and Aims: We previously reported a 30-day mortality following percutaneous endoscopic gastrostomy (PEG) of 8% (1988–92). Concerns over increasing mortality rates prompted us to survey current practice compared with 1988–92: assess case mix, outcome, risk factors for early death, and review practice guidelines. Methods: 78 consecutive adults were referred for PEG over 7 months. Baseline characteristics, including age and functional status (Barthel Index), and outcome at 30 and 180 days were prospectively evaluated. Results: 74 patients. Median age 69 years; male 55%. Major underlying diagnoses: cerebrovascular disease 42%, head and neck tumours 19%, motor neurone disease 4% (33%, 16% and 27% in 1988–92). Mortality rates at 30, 90 and 180 days were 19%, 35% and 42% respectively (8%, 20% and 37% in 1988–92). Univariate analysis showed that age >75 years, Barthel Index <1 and Glasgow Coma Scale ≤10 were significant risk factors for death at 30 days: odds ratios (95% confidence intervals) 3.9 (1.1–13), 5.9 (1.4–25) and 4.4 (1.2–15) respectively. Conclusions: 30-day mortality was increased from 8% to 19% between 1988–92 and 1998–99 reflecting a change in referral patterns: more elderly with cerebrovascular disease and fewer with motor neurone disease. Age and functional status should be considered when advising on PEG feeding.