Recent experience with PEG tube insertion in Connolly Hospital
B.Christopher, K.Altamimi, H.Elmileik, R.Farrell, C.Smyth
Department of Gastroenterology, Connolly Hospital Blanchardstown
Percutaneous Endoscopic Gastrostomy (PEG) tube is an important means to provide enteral nutrition in a selected subgroup of patients. The decision to insert a PEG tube is usually made using a multidisciplinary approach with clear discussion with patients and family.
The aim of this study was to look at our patient cohort in Connolly Hospital Blanchardstown who have had a PEG tube inserted between January 2014 and August 2015. As comparison in the previous 12 months, there were 11 PEG tubes inserted. We evaluated the indications for PEG tube insertion, by whom the decision was made, time between presentation on acute illness and referral for PEG insertion, patients’ age, sedation used and any immediate complications related to the procedure.
We obtained data from EndoRAAD database, chart review and phone contact to relatives and general practitioners.
23 patients had PEG tubes inserted over the duration of this audit. The indications for PEG insertion were as follow: - Stroke (n = 6 /26%), learning impairment (cerebral palsy, Trisomy 21) with recurrent aspiration pneumonia (n= 5 / 21.7%) dementia with reduced oral intake (n =3 / 13 %), Inclusion body myositis (n =2 / 8.7%), Myasthenia Gravis (n= 1 / 4.3%), brain Injury, dysphagia (n= 1 / 4.3%)Hereditary spastic paraparesis (n=1 / 4.3%),Progressive mitochondrial myopathy (n= 1 / 4.3%), Subarachnoid Haemorrhage, dysphagia (n = 1 / 4.3%), Huntington’s chorea with recurrent aspiration (n = 1 / 4.3%) and Progressive Parkinson’s disease with multisystem atrophy (n= 1 / 4.3%). Decision for insertion was made by stroke physician (26%) and other medical physician – 74% (neurologist, gastroenterologist, primary physicians). Time frame from event or diagnosis to insertion was variable. The only definitive time frame was for severe stroke patients when the average time to PEG insertion being 5 weeks. There were 13 females (56.5%) and 10 males (43.5%) in terms of gender distribution. The average age was 65 years old (range 32 – 87). For sedation, the average use of midazolam was 3.75mg, Fentanyl 50 mcg and Pethidine 25mg. There were no documented immediate complications in this cohort.
PEG feeding is an important intervention treatment when used in the right cohort of patients. A multidisciplinary approach is crucial in the decision making process. We plan to prospectively assess all referrals for PEG tube to ensure clear and appropriate patient selection at all times. Our retrospective study showed that our patients were carefully selected and did benefit from PEG feeding.