PEG TUBE INSERTION: ENHANCED NEED FOR GREATER SELECTIVITY IN PATIENT REFERRAL

Introduction: Percutaneous endoscopic gastrostomy (PEG) refers to insertion of a tube into the stomach percutaneously, aided by endoscope and was first described in 1980 by Gauderer. This was devised for feeding the patients who have swallowing problems due to any reason especially neurodisability. There is an enhanced need for greater selectivity in patient referral. Retrospective, single – institution case series. The study was performed in Waterford Regional Hospital, Water- ford, Ireland. Jan 2003 to Dec 2007. Materials and Methods: A total of 203 consecutive patients referred for nutritional support under- went PEG tube insertion during this period. Written informed consent was taken from all the par- ticipants or their attendants and the procedure was performed with prophylactic antibiotic and under intravenous sedation. Standard PEG set was used for the procedure. Feeding was started 12 hours after tube placement and care instructions were given. The parameters of study included in- dications, annual frequency, and overall outcome. Results: A total of 203 patients having a male to female ratio 1:0.7 underwent PEG tube insertion. The age ranged from 26 to 96 years (mean 79 + 5.17. The mean duration of PEG feeding was 93 (3- 785) days. The annual frequency of insertion increased from 19 (9.3%) patients in 2003 to 64 pati- ents (31.5%) in 2007. The length of stay ranged from 1 to 350 days (median 93). In this cohort, 32 (15.7%) patients died during the same admission. A total of 79 (38.9%) were discharged for home, 92 (45.3%) were discharged back to nursing home care. Conclusion: This study underscores the need for enhanced awareness and protocol – driven selec- tivity in patient referral for PEG tube insertion.