The 2004 NCEPOD report highlighted the high 30 day mortality following PEG (percutaneous endoscopic gastrostomy) insertion secondary to inappropriate patient selection. 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.Introduction
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.Introduction
Our Aim was to assess whether the implementation of a nutritional team PEG service reduced 30 day all-cause mortality.Methods
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.Results
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=0.0048Conclusions
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.Conclusions
By introducing an NTS and PEG service mortality has reduced significantly. With an ever increasing ageing population, trends in PEG placement are rising. It is a necessity to ensure that patients are being appropriately assessed to prevent futile procedures.