PWE-110 unvetted pig versus peg service with nutrition support team. have we improved mortality?

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The 2004 NCEPOD report highlighted the high 30 day mortality following PEG (percutaneous endoscopic gastrostomy) insertion secondary to inappropriate patient selection[1]. This led to the 2010 BSG guidelines which recommended that a designated nutrition support team (NST) should provide a framework for patient selection to reduce unsuitable patients receiving PEGs[2].


Prior to 2013 in Stockport NHS Foundation trust PIGs (per-oral image-guided gastrostomy) were inserted or patients referred to another trust for PEG placement. There was no formalised referral or screening process. Subsequently a nutrition team was appointed with inpatient assessment of patients and MDT for complex cases.


Our Aim was to assess whether the implementation of a nutritional team PEG service reduced 30 day all-cause mortality.


Retrospective analysis of electronic patient records for 30 day all-cause mortality for all PIG and PEG insertions between 2013 and 2017. Statistical analysis was performed using chi-squared.


48 patients (2 excluded as paediatric case and no notes available) had a PIG inserted without formal nutrition team review and 135 patients had PEG following nutrition nurse or MDT assessment. The 2 groups were similar with an average age of 79 years (PIG) and 76 years (PEG) and the majority inserted for stroke (62% PIG and 50% PEG). 30 day mortality on the non-vetted PIG group was 17.4% compared to 5.2% in the PEG group. This was statistically significant with p=0.0048


For the unassessed PIG service mortality was similar to that detailed by the NCEPOD report, demonstrating that despite this and BSG guidelines attitudes towards PEG/PIG insertion among non-specialists have not changed since 2004.


By introducing an NTS and PEG service mortality has reduced significantly. With an ever increasing ageing population, trends in PEG placement are rising[3]. It is a necessity to ensure that patients are being appropriately assessed to prevent futile procedures.

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