Gastropexy can be as safe as conventional percutaneous endoscopic gastrostomy (PEG), and biomarkers do not predict short-term or long-term outcomes: a 7-year follow-up audit

• Published in: Frontline gastroenterology Vol. 11; no. 5; pp. 364 - 370
• Main Authors: Porter, Ross J, McKinlay, Alastair W, Metcalfe, Emma L
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Clinical medicine; Endoscopy; Enteral nutrition; Gastroenterology; Hemoglobin; Mortality; Neutrophils; Ostomy; Patients; Peritonitis; Phosphatase; Survival analysis; United Kingdom > UK; nutrition; PEG; gastrostomy
• ISSN: 2041-4137; 2041-4145
• DOI: 10.1136/flgastro-2019-101306

ObjectiveGastrostomy facilitates artificial enteral feeding but controversy exists around associated morbidity and mortality. This study aimed to report short and long-term outcomes, and identify parameters associated with overall survival.MethodsA 7-year follow-up audit was undertaken at Aberdeen Royal Infirmary, UK. All patients undergoing endoscopic gastrostomy insertion October 2011–September 2018 were included. Last follow-up was February 2019. Clinical data were prospectively collected. Blood results were retrospectively obtained from electronic records. Statistical analysis was with IBM SPSS V.25.Results691 procedures were performed over the 7-year period (520 traditional pull-through percutaneous endoscopic gastrostomy (PEG) and 171 gastropexy procedures to facilitate gastrostomy). Frequency of complications (gastrointestinal bleeding, perforation and peritonitis) was low (each n=1). Overall 7-day and 30-day mortality was 2.2% and 8.4%, respectively. One-year mortality reached 47.6%. There was no difference in survival between PEG and gastropexy procedures (p=0.410). Multivariate analysis reported increased age (p<0.001), increased alkaline phosphatase (p<0.001) and clinical indication (p=0.002) as independently associated with an increased hazard of death. Only age was moderately predictive of mortality (area under the curve 0.74, 95% CI 0.70 to 0.78, p<0.001) in the PEG group. Clinical indication was the only parameter independently associated with mortality in the gastropexy cohort (p=0.003).ConclusionEndoscopic gastrostomy placement can be safe with a low mortality and low risk of serious complications. Blood markers were not associated with short-term or long-term outcomes. Gastropexy to facilitate gastrostomy is a safe alternative to traditional pull-through PEG procedures. Future work should consider quality of life outcomes to assess the benefit of gastrostomy from a patient perspective.