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Original research
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
  1. Ross J Porter1,2,
  2. Alastair W McKinlay2,
  3. Emma L Metcalfe2
  1. 1 Institute of Medical Sciences, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
  2. 2 Aberdeen Royal Infirmary Department of Digestive Disorders, NHS Grampian, Aberdeen, UK
  1. Correspondence to Dr Emma L Metcalfe, Aberdeen Royal Infirmary Department of Digestive Disorders, NHS Grampian, Aberdeen AB25 2ZN, UK; emma.metcalfe{at}nhs.net

Abstract

Objective Gastrostomy 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.

Methods A 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.

Results 691 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).

Conclusion Endoscopic 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.

  • PEG
  • gastrostomy
  • nutrition
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Footnotes

  • Contributors All authors who met the authorship criteria certify they sufficiently contributed to this work. Other contributors are listed under acknowledgements. ELM was the senior/principal investigator for this project. RJP, ELM and AWMcK contributed to study conception and design. ELM collected data prospectively and RJP collected retrospective data. RJP analysed the data and RJP, AWMcK and ELM interpreted data analysis. RJP and ELM wrote the first draft of the manuscript. RJP, ELM and AWMcK contributed to revisions prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Caldicott Guardian approval was granted for this project from Professor Nick Fluck, Caldicott Guardian for NHS Grampian (CG 2018/079).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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