Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement by an Emergency General Surgery Service: Long-Term Follow-Up is Lacking

• Published in: The American surgeon 2019-07, Vol.85 (7), p.323-325
• Main Authors: DesPain, Robert W., Parker, William J., Kindvall, Angela T., Elster, Eric A., Jessie, Elliot M., Rodriguez, Carlos J., Bradley, Matthew J.
• Format: Article
• Language: English
• Subjects: Aftercare - standards; Electronic health records; Electronic medical records; Emergency Treatment - standards; Endoscopy; Enteral feeding; Enteral nutrition; Gastrostomy - methods; Geriatrics; Head & neck cancer; Health care facilities; Health sciences; Hospitals; Humans; Intubation, Gastrointestinal - methods; Mechanical ventilation; Nutrition; Ostomy; Patients; Surgeons; Surgery; Trauma; Ventilation
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481908500704

More than 200,000 percutaneous endoscopic gastrostomy (PEG) tubes are placed each year, with most of those occurring in elderly patients.1 The primary indication for enteral feeding is to provide nutritional support in patients who cannot meet their caloric and elemental needs through oral intake because of a variety of medical conditions, including head and neck cancer, stroke, or severe respiratory distress requiring prolonged mechanical ventilation. After PEG tube insertion, these patients are often managed by their primary teams and discharged from the hospital without surgical follow-up. [...]once discharged, the responsibility for managing the PEG may come into question. In 2016, as part of a PI initiative, the Division of TACS at Walter Reed National Military Medical Center created an EGS PI program similar to but separate from our already established trauma PI program, complete with an EGS registry, a registrar, and a PI coordinator.3 As part of our EGS registry, all patients meeting the defined criteria of EGS patients using a modified set of the American Association for the Surgery of Trauma's list of EGS diagnoses, both operative and nonoperative, underwent abstraction of their electronic medical record for the first 30 days of hospitalization. Of the tubes removed, 4 (36%) were initially placed for head and neck surgery and 7 (64%) were placed for neurologic reasons (Table 2). [...]50 per cent of PEG tubes placed for head and neck surgery and 35 per cent of PEG tubes placed for neurologic reasons were removed.