Pneumonia and mortality after percutaneous endoscopic gastrostomy insertion

Neville AZZOPARDI, Pierre ELLUL
2013 The Turkish Journal of Gastroenterology  
Amaç: Perkütan endoskopik gastrostomi nörolojik disfajisi olan hastalarda enteral beslenme imkan› sunmaktad›r. Otuz günlük mortalite oranlar› %4-26 aras›nda de¤iflmektedir ve perkütan endoskopik gastrostomi yerlefltirilmesinden sonra pnömoni s›kt›r. Gereç ve Yöntem: Bu çal›flma Malta'da gerçeklefltirilen (Ocak 2008-Haziran 2010 perkütan endoskopik gastrostomi ifllemlerinin retrospektif analizini içermektedir ve hastalar›n nazogastrik tüp ile beslendikleri dönem ile perkütan endoskopik
more » ... ndoskopik gastrostomi ile beslendikleri dönemdeki pnömoni s›kl›klar› karfl›laflt›r›lm›flt›r. Ayr›ca perkütan endoskopik gastrostomi uygulamas›n›n endikas-yonlar›, kötü prognostik faktörleri ve mortalitesi incelenmifltir. Bulgular: Doksanyedi hastaya perkütan endoskopik gastrostomi uyguland›. Bunlardan 54'ü perkütan endoskopik gastrostomi öncesi dönemde nazogastrik tüp ile beslenmifldi. Nazogastrik tüp ile beslenen hastalarda toplam 7884 günde 32 pnömoni vakas› (1 pnömoni/246 gün) tespit edildi. Nazogastrik tüp ile beslenme ertesinde perkütan endoskopik gastrostomi aç›lan hastalarda 36238 günde 48 pnömoni geliflti¤i (1 pnömoni/755 gün) tespit edildi. Nazogastrik tüp ile beslenme dönemi olmaks›z›n perkütan endoskopik gastrostomi aç›lan hastalarda 23983 günde 28 pnömoni (1 pnömoni/856 gün) tespit edildi (Chi-kare; p<0.005). Veri toplanmas› s›ras›nda 47 hasta vefat etmiflti ve bunlarda 29'u pnömoniye ba¤-l›yd›. Haftal›k mortalite %3, ayl›k mortalite %8 ve 1 y›ll›k mortalite %39 olarak tespit edildi. ‹fllemden sonraki 1 hafta içinde ölümlerin tamam› ve 1 ay içindeki ölümlerin %50'si pnömoniye ba¤l› geliflti. Sonuç: Nazogastrik tüp ile beslenme ile karfl›laflt›r›ld›¤›nda perkütan endoskopik gastrostomi aç›lan hastalarda pnömoni s›kl›¤›nda anlaml› bir azalma kaydedilmektedir. Her fleye ra¤men perkütan endoskopik gastrostomi aç›lan hastalarda pnömoni en önemli ölüm nedenidir. Anahtar kelimeler: Gastrostomi, perkütan endoskopik gastrostomi, pnömoni, nazogastrik Background/aims: Percutaneous endoscopic gastrostomy feeding provides enteral nutrition to patients with neurological dysphagia. Thirty-day mortality rates of 4-26% have been reported, with pneumonia being the common cause post-percutaneous endoscopic gastrostomy insertion. Materials and Methods: This retrospective analysis of percutaneous endoscopic gastrostomy tube insertions in Malta (January 2008 -June 2010) compares the incidence of pneumonia in patients fed through a nasogastric tube versus in those fed via a percutaneous endoscopic gastrostomy tube. We analyzed the indications, poor prognostic factors and mortality for percutaneous endoscopic gastrostomy insertion. Results: Ninety-seven patients underwent percutaneous endoscopic gastrostomy insertion. Fifty-four patients received nasogastric feeds before percutaneous endoscopic gastrostomy feeds. Patients on nasogastric feeds developed 32 episodes of pneumonia over a total of 7884 days of feeds (1 every 246 days). Patients with percutaneous endoscopic gastrostomy feeds after a period of nasogastric feeds developed 48 pneumonia episodes over 36,238 days (1 every 755 days). Patients with percutaneous endoscopic gastrostomy feeds without previous nasogastric feeds developed 28 pneumonia episodes over 23,983 days (1 every 856 days), and this was statistically significant (χ 2 test p value <0.005). Forty-seven patients had died at the time of data collection, with 29 patients dying from pneumonia. One-week mortality was 3%, 30-day mortality was 8% and 1-year mortality was 39%. All patients dying within the first week and 50% of those dying within 30 days of the procedure died following pneumonia. Conclusions: There was a statistically significant decrease in the number of pneumonia episodes among patients receiving percutaneous endoscopic gastrostomy feeds versus nasogastric feeds. However, pneumonia is still the major cause of death among percutaneous endoscopic gastrostomy patients.
doi:10.4318/tjg.2013.0512 pmid:23934456 fatcat:qcw4lmtg7fgmrinclljfj7rhri