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

I. Tanswell, MBChB^*, D. Barrett, RGN^*, C. Emm, BSc, W. Lycett, BSc, C. Charles, MRSLT, K. Evans, MD^|| and S. D. Hearing, MD^*

From the Departments of ^* Gastroenterology, Dietetics, Pharmacy, Speech and Language Therapy, and ^|| Chemical Pathology, Staffordshire General Hospital, Stafford, United Kingdom

Correspondence: Ian J. Tanswell, Hereford County Hospital, Union Walk, Hereford HR1 2ER, United Kingdom. Electronic mail may be sent to ian.tanswell{at}hhtr.nhs.uk.

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.

Journal of Parenteral and Enteral Nutrition, Vol. 31, No. 3, 205-211 (2007)
DOI: 10.1177/0148607107031003205


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