Zeynep GÖKTAŞ, Metın UZMAN, Evrim KAHRAMANOĞLU AKSOY, Muhammet AKPINAR, Ferdane SAPMAZ, Yaşar NAZLIGÜL

Perkütan Endoskopik Gastrostomi Takılan Hastaların Uzun Dönem Takip Sonuçları ve Sağkalımı Etkileyen Faktörler

Amaç: Perkütan endoskopik gastrostomi (PEG), etkinlik ve güvenilirliği iyi bilinen, oral beslenemeyen hastalarda sıklıkla uygulanan minimal invazivbir yöntemdir. Literatürde PEG uygulanan hastalarda uzun dönem takip sonuçlarını inceleyen çalışmalar kısıtlıdır. Biz bu çalışmada PEG uygulananhastalarda uzun dönem takip sonuçlarını ve mortaliteyi etkileyen faktörleri ortaya koymayı amaçladık.Gereç ve Yöntem: Ocak 2013-Haziran 2018 tarihleri arasında PEG takılan 203 hasta retrospektif olarak değerlendirildi. Hastaların demografiközellikleri, işlem sonrası takip süreleri, varsa komplikasyonları, PEG endikasyonları, işlem sırasındaki laboratuvar parametreleri hasta dosyalarındankaydedildi. Takip süreleri boyunca hastalarda mortalite oluşumu ve zamanı, ölüm bildirim sistemi üzerinden tespit edildi.Bulgular: Çalışmaya toplam 203 hasta (101 erkek, 102 kadın) dahil edildi. Hastaların ortanca yaşları 77 idi (18-96). En sık PEG endikasyonu %34sıklıkta inme olarak gözlenirken bunu demans (%28,6), malignite (%10,8) ve diğer (%15,8) nedenler takip etti. Ortanca takip süresi 33,6 ay (30,5-36,7), ortanca sağkalım süresi 22 ay [%95 güven aralığı (CI): 22,8-30,5] olarak tespit edildi. Hastaların mortalite oranları ilk 1 ayda %1,5, 3 ayda %3,1 yılda %12,3, 2 yılda 26,6, 3 yılda %34,5, 5 yılda %44,3 olarak bulundu. PEG endikasyonları mortalite arasında ilişki saptanmazken hiponatremi ilemortalite arasında istatistiksel olarak anlamlı bir ilişki saptandı (olasılık oranı: 1,07; p=0,027; %95 CI).Sonuç: PEG endikasyonları mortalite arasında ilişki saptanmazken hiponatremi ile mortalite arasında istatistiksel olarak anlamlı bir ilişki saptandı.

Long-term Follow-up Results of Patients with Percutaneous Endoscopic Gastrostomy and Factors Affecting Survival

Objectives: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure with well-known efficacy and safety that is frequently used in patients who cannot be fed orally. In the literature, studies investigating long-term follow-up results in patients undergoing PEG are limited. In this study, we aimed to determine the long-term follow-up results and the factors affecting mortality in patients undergoing PEG. Materials and Methods: Two hundred and three patients who underwent PEG placement between January 2013 and June 2018 were evaluated retrospectively. The demographic characteristics of the patients, postoperative follow-up times, complications, PEG indications, laboratory parameters during the procedure were recorded from the patient files. During the follow-up period, the mortality and time of the patients were determined via the death notification system. Results: A total of 203 patients (101 male, 102 female) were included in the study. The median age of the patients was 77 years (18-96). The most frequent PEG placement indication was stroke with a frequency of 34%, followed by dementia (28.6%), malignancy (10.8%) and other (15.8%) reasons. The median follow-up period was 33.6 months (30.5-36.7) and the median survival was 22 months [95% confidence interval (CI): 22.8-30.5]. Mortality rates were 1.5% in the first month, 3% in 3 months, 12.3% in 1 year, 26.6 years in 2 years, 34.5% in 3 years and 44.3% in 5 years. There was no correlation between PEG indications and mortality, but there was a statistically significant correlation between hyponatremia and mortality (Odds ratio: 1.07, p=0.027, %95 CI). Conclusion: There was no statistically significant relationship between PEG placement indications and mortality, but there was a statistically significant correlation between hyponatremia and mortality.

PDF

___

1. Gauderer WL, Ponsky JL, İzant RJ. Gastrostomy without laparatomy: a percutaneous endoscopic technique. J Pediatry Surg. 1980;15:872-875.
2. Ponsky JL, Gauderer MW, Stellato TA. Percutaneous endoscopic gastrostomy. Review of 150 cases. Arch Surg. 1983;118:913-914.
3. Lucendo AJ, Friginal-Ruiz AB. Percutaneous endoscopic gastrostomy: An update on its indications, management, complications, and care. Rev Esp Enferm Dig. 2014;106:529-539.
4. Hucl T, Spicak J. Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol. 2016;30:769-781.
5. Friginal-Ruiz AB, Lucendo AJ. Percutaneous Endoscopic Gastrostomy: A Practical Overview on Its Indications, Placement Conditions, Management, and Nursing Care. Gastroenterol Nurs. 2015;38:354-366
6. Nair S, Hertan H, Pitchumoni CS. Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia. Am J Gastroenterol. 2000;95:133-136.
7. Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci. 2000;55:735-739.
8. Finocchiaro C, Galletti R, Rovera G, et al. Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition. 1997;13:520-523.
9. Amann W, Mischinger HJ, Berger A, et al. Percutaneous endoscopic gastrostomy (PEG). 8 years of clinical experience in 232 patients. Surg Endosc. 1997;11:741-744.
10. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ. 1994;308:945-948.
11. Heyland DK. Nutritional support in the critically ill patient: a critical reviewof the evidence. Crit Care Clin. 1998;14:423-440.
12. Braunschweig CL, Levy P, Shehan PM, et al. Enteral compared with parenteral nutrition: a meta–analysis. Am J Clin Nutr. 2001;74:534-542.
13. DeLegge MH. Enteral Access and Associated Complications. Gastroenterol Clin North Am. 2018;47:23-37.
14. Roche V. Percutaneous endoscopic gastrostomy. Clinical care of PEG tubes in older adults. Geriatrics. 2003;58:22-29.
15. Grant DG, Bradley PT, Pothier DD, et al. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multiinstitution study, systematic review and meta-analysis. Clin Otolaryngol. 2009;34:103-112.
16. Rimon E, Kagansky N, Levy S. Percutanous endoscopic gastrostomy; evidence of different prognosis in various patients subgroups. Age Ageing. 2005;34:353-357.
17. Richter-Schrag HJ, Richter S, Ruthmann O, et al. Risk factors and complications following percutaneous endoscopic gastrostomy: a case series of 1041 patients. Can J Gastroenterol. 2011;25:201-206.
18. Light VL, Slezak FA, Porter Gerson LW, et al. Predictive factors for early mortality after percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1995;42:330-335.
19. Zopf Y, Maiss J, Konturek P, et al. Predictive factors of mortality after PEG insertion: guidance for clinical practice. JPEN J Parenter Enteral Nutr. 2011;35:50-55.
20. Callahan CM, Haag KM, Weinberger M, et al. Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc. 2000;48:1048-1054.
21. Kara O, Kizilarslanoglu MC, Canbaz B, et al. Survival After Percutaneous Endoscopic Gastrostomy in Older Adults With Neurologic Disorders. Nutr Clin Pract. 2016;31:799-804.
22. Schurink CA, Tuynman H, Scholten P, et al. Percutaneous endoscopic gastrostomy: complications and suggestions to avoid them. Eur J Gastroenterol Hepathol. 2001;13:819-823.
23. Sanders DS, Carter MJ, D’Silva J, et al. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol. 2000;95:1472-1475.
24. Pih GY, Na HK, Ahn JY, et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion. BMC Gastroenterol. 2018;18:101.