Percutaneous endoscopic gastrostomy: dealing with the issue of dislodgement

Abstract

Introduction: Percutaneous Endoscopic Gastrostomy (PEG) is accepted as an efficient method to provide long-term enteral nutrition. PEG accidental dislodgement (device exteriorization confirmed by expert evaluation) rate is high and can lead to major morbidity.

Objective: To identify independent risk factors for PEG accidental dislodgement.

Methods: Retrospective, single-center study, including consecutive patients submitted to PEG procedure, for 38 consecutive months. Every patient had 12 months minimum follow-up after PEG placement. Univariate analysis selected variables with at least marginal association (p < .15) with the outcome variable, PEG dislodgement, which were included in a logistic regression multivariate model. Discriminative power was assessed using area under curve (AUC) of the receiver operating curve (ROC).

Results: We included 164 patients, 67.7% (111) were female, mean age was 81 years. We report 59 (36%) PEG dislodgements, of which 13 (7.9%) corresponded to early dislodgements. The variables with marginal association were hypoalbuminemia (p = .095); living at home (p = .049); living in a nursing home (p = .074); cerebrovascular disease (CVD) (p = .028); weight change of more than 5 kg, either increase or decrease (p = .001); psychomotor agitation (p < .001); distance inner bumper-abdominal wall (p = .034) and irregular appointment follow-up (p = .149). At logistic multivariate regression, the significant variables after model adjustment were CVD OR 4.8 (CI 95% 2.0–11.8), weight change OR 4.7 (CI 95%1.6–13.9) and psychomotor agitation OR 18.5 (CI 95% 5.2–65.6), with excellent discriminative power (AUC ROC 0.797 [CI95% 0.719–0.875]).

Conclusion: PEG is a common procedure and accidental dislodgement is a frequent complication. CVD, psychomotor agitation and weight change >5 kg increase the risk of this complication and should be seriously considered when establishing patients’ individual care requirements.

Keywords:

• Percutaneous endoscopic gastrostomy
• PEG complication
• dislodgment

Authors’ contributions

Rui de Sousa Magalhães was involved in all stages of the manuscript construction: from the conduct, reporting, conception and design, to the acquisition of data or analysis, literature review and writing the final paper; Tiago Cúrdia Gonçalves was involved in the conception, design and discussion of the final paper to be published; Bernardo Sousa Pinto was involved in the statistical analysis and in the discussion of the final paper to be published; Bruno Rosa was involved in the conception, design and discussion of the final paper to be published; Carla Marinho was involved in the discussion of the final paper to be published; José Cotter was involved in the conception, design and discussion of the final paper to be published.

Disclosure statement

The authors report no conflict of interest.

References