Original articleClinical endoscopyDeath after PEG: results of the National Confidential Enquiry into Patient Outcome and Death
Section snippets
Patients and methods
All inpatient deaths within 30 days of an upper GI endoscopy and PEG tube insertion were identified by Office of Population Censuses and Surveys codes and included in the study. Postal questionnaires were sent to the consultant responsible for performing the endoscopic procedure. The endoscopist was asked to grade the anticipated risk of death within 30 days. The data were assessed by an independent panel of experts for comments. This was a multidisciplinary group comprising upper and lower GI
Patients
A total of 719 patients (391 male, median age 80 years, range 26-98 years) who died within 30 days after PEG insertion were identified. Of these, 588 (82%) were 70 years or older. Coexisting medical diagnoses are detailed in Table 1. Four hundred two patients (56%) had respiratory disease, 338 (47%) patients had cardiac disease, and 695 (97%) had neurologic disease (multiple responses permitted). Four patients had known liver cirrhosis, one of whom one was Child-Pugh A and three were Child-Pugh
Discussion
Previous studies have shown that gastrostomies are generally safe procedures, with a low risk of complications and a low procedure-related mortality rate independent of the technique used.4, 5 In spite of the ease with which gastrostomy may be performed by the percutaneous method, patient selection must be appropriate if results are to remain acceptable.6 Contraindications to PEG insertion include the presence of large-volume ascites, total esophageal obstruction, coagulation disorders, and
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Tracheostomies and PEGs: When Are They Really Indicated?
2019, Surgical Clinics of North AmericaEnteral Access and Associated Complications
2018, Gastroenterology Clinics of North AmericaCitation Excerpt :However, the most common intraprocedure complications are orotracheal aspiration during the endoscopic procedure and bowel perforation from inadvertent trocar access through the colon as the stomach is being accessed. Prevention of orotracheal aspiration includes attention to mouth and tracheal secretion suctioning during the procedure, head of the bed elevation, and avoidance of oversedation of the patient.28 Inadvertent bowel perforation can be minimized by avoiding trocar access of the gastric cavity unless adequate endoscope light transillumination and finger palpation are present.