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?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?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.