| Home | E-Submission | Sitemap | Editorial Office |  
top_img
Clin Endosc > Volume 51(1); 2018 > Article
Shin and Lee: Is Percutaneous Endoscopic Gastrostomy Acceptable in Centenarian Patients?
See "Safety of Percutaneous Endoscopic Gastrostomy Tubes in Centenarian Patients” by Zain A Sobani, Kevin Tin, Steven Guttmann, et al., on page. 56-60.
Enteric tube feeding is recommended for patients with dysphagia to achieve adequate nutritional supplementation and to prevent complications such as aspiration pneumonia. In stroke patients, clinical outcomes may be better if feeding is started earlier. In the short term, nasogastric tube (NGT) feeding is acceptable, and there is no clear advantage of percutaneous endoscopic gastrostomy (PEG) over NGT feeding. However, complications including esophageal ulcer, stricture, aspiration pneumonia, and sinusitis are increased if NGT feeding continues for more than 4 weeks. Compared with NGT feeding, PEG feeding reduced treatment failures and gastrointestinal bleeding, and achieved higher feed delivery and albumin concentration [1]. Thus, PEG feeding can be recommended for dysphagia patients who require long-term nutritional support.
Technically, PEG placement is simple and safe [2]. However, it has a risk of procedure-related death and complications including bleeding, aspiration pneumonia, perforation of the aerodigestive tract, immediate or delayed gastrostomy site infection, and colocutaneous fistula formation [3]. In addition, despite the increasing number of older patients, it remains unclear whether and when PEG placement should be performed [4]. In-hospital mortality is reportedly higher in older patients, especially in those over 75 years old [5,6]. Therefore, PEG placement should be performed selectively in patients with dysphagia, according to their life expectancy. Future studies are warranted on the safety and effectiveness of PEG placement based on comorbidity, age, sex, and gastrostomy technique [7].
In this issue of Clinical Endoscopy, Sobani et al. investigated the safety of PEG tube placement in patients aged 100 years or older [8]. They reported that the success rate and in-hospital mortality were comparable in centenarian and younger patients (p>0.05), although minor complication rates were significantly higher in the centenarian patients (13.3% vs. 2.9%, p=0.022). The authors concluded that PEG tube placement may be safely attempted in carefully selected patients in this subset of the population. The study has limitations as it was a retrospective single-center study, and selection bias might be unavoidable. Nevertheless, this is the first study regarding this issue, and more studies are warranted in the future.

NOTES

Conflicts of Interest:The authors have no financial conflicts of interest.

REFERENCES

1. Geeganage C, Beavan J, Ellender S, Bath PM. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst Rev 2012;10:CD000323.
crossref pmid
2. O’Mahony S. Difficulties with percutaneous endoscopic gastrostomy(PEG): a practical guide for the endoscopist. Ir J Med Sci 2013;182:25-28.
crossref pmid
3. Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987;93:48-52.
crossref pmid
4. Moran C, O’Mahony S. When is feeding via a percutaneous endoscopic gastrostomy indicated? Curr Opin Gastroenterol 2015;31:137-142.
crossref pmid
5. Arora G, Rockey D, Gupta S. High in-hospital mortality after percutaneous endoscopic gastrostomy: results of a nationwide population-based study. Clin Gastroenterol Hepatol 2013;11:1437-1444.e3.
crossref pmid
6. Wirth R, Voss C, Smoliner C, Sieber CC, Bauer JM, Volkert D. Complications and mortality after percutaneous endoscopic gastrostomy in geriatrics: a prospective multicenter observational trial. J Am Med Dir Assoc 2012;13:228-233.
crossref pmid
7. Gomes CA Jr, Andriolo RB, Bennett C, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev 2015;(13):CD008096.
pmid
8. Sobani ZA, Tin K, Guttmann S, Abbasi AA, Mayer I, Tsirlin Y. Safety of percutaneous endoscopic gastrostomy tubes in centenarian patients. Clin Endosc 2018;51:56-60.
crossref pmid pmc pdf
Editorial Office
Korean Society of Gastrointestinal Endoscopy
#817, 156 Yanghwa-ro(LG Palace, Donggyo-dong), Mapo-gu, Seoul, 04050, Korea
TEL: +82-2-335-1552   FAX: +82-2-335-2690    E-mail: ksge@gie.or.kr
About |  Browse Articles |  Current Issue |  For Authors and Reviewers
Copyright © Korean Society of Gastrointestinal Endoscopy. All rights reserved.