Assessment by a Multidisciplinary Clinical Nutrition Team Before Percutaneous Endoscopic Gastrostomy Placement Reduces Early Postprocedure Mortality

Abstract

Background: The purpose of this study was to determine whether preassessment by a multidisciplinary nutrition team before percutaneous endoscopic gastrostomy (PEG) placement can reduce postprocedure mortality. This was a prospective single-center audit. Methods: Patients who had been referred to the Gastroenterology Department for consideration of PEG placement between 1995 and 2004 were included. In the index year, 2003–2004, where a formal nutrition team assessment was commenced, 79 patients were enrolled into our study group on a consecutive basis. These patients were subdivided into 3 groups; group A, PEG placed (51 patients); group B, PEG not placed due to severe comorbidity (19 patients); and group C, PEG not placed as deemed unnecessary (9 patients). Comparison was made with previous years where no formal preassessment had occurred. At Staffordshire General Hospital, a comparison of mortality post-PEG placement was made between the index group and previous years. Secondary measures included complication rates and frequency of biochemical monitoring. Results: One week post-PEG mortality fell from 10%–20% in previous years to 0% in the index year (p < .02). This improved survival extended to 3 months postprocedure (p < .016). Three patients (6%) had biochemical evidence of refeeding syndrome postplacement. Biochemical monitoring was inadequate, with only 27/51 (53%) patients being completely monitored. No complications pertaining to the endoscopy were reported. Conclusions: This study demonstrates that early post-PEG mortality can be reduced by preassessment of patients by a multidisciplinary nutrition team and is evidence supporting the recommendations of the National Confidential Enquiry into Patient Outcome and Death report.

A study designed to assess the impact of a clinical nutrition team on post percutaneous endoscopic gastrostomy (PEG) survival. It supports recent NCEPOD (National Confidential Enquiry into Patient Outcome and Death) recommendations regarding the role of a nutrition team in the selection of patients for PEG placement and the importance of careful biochemical monitoring in the postprocedure period.

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