Introduction Abdominal pain following percutaneous endoscopic gastrostomy (PEG) placement is a recognised complication considered to be secondary to a chemical peritonitis. However, the prevalence and degree of severity of pain is poorly characterised. Abdominal pain following liver biopsy is strongly linked to preprocedural anxiety levels1. We assessed abdominal pain and anxiety associated with PEG placement.
Methods A prospective questionnaire assessed patient anxiety and abdominal pain 1 hour (h) pre PEG placement, 1h post and 24h post using a 10-point Likert scale. The questionnaire was completed by the patient where possible or clinician if not. Abdominal pain was assessed by examination at 1h post procedure. 24h post procedure complications and analgesia requirements were recorded. Patient’s Mini Mental Score (MMSE, 0–30) and Barthel index (0–20) were completed.
Results 70 consecutive patients (M:F 45:25) median age 61.5 (19–94) were assessed. The commonest indications were head and neck malignancies (44%) and stroke (11%). PEG placement was on first attempt in 68 cases, with no clinical complications.
Mean (StD), MMSE, Barthel, anxiety and pain scores.
24 self-reporting patients had a pain score of 1–3 at 1h post placement and 20 at 24 h. 3 patients reported a pain score of 7–10 at 1 h post placement and 7 at 24 h. 21/49 self-reporting patients and 0/21 non self-reporting had PEG site and/or general abdominal tenderness on clinical examination at 1h.
Pain post PEG placement was noted in only 1 clinician-assessed patient. This was at 24 h. 50.7% of patients took analgesia at 24 hours post procedure (all self-reporting). Regression showed no relationship between pre placement anxiety and post placement pain.
Conclusion Pain at 1h post PEG placement was common in self-reporting patients and usually mild. By 24h, 41% reported moderate to severe pain often taking analgesia. Preprocedural anxiety did not predict post procedural pain. Clinician examination of all patients at 1h did correlate with self-reported discomfort or predict self reported pain at 24h. Clinician assessment at 1h and 24h where patients could not self assess failed to identify pain. After PEG placement patients should be offered advice on pain and given access to analgesia. It is likely that pain is not identified in debilitated patients and clinicians need to be more alert to its possible presence.
Disclosure of Interest None Declared
Riley T. Predictors of pain medication use after percutaneous liver biopsy. Digest Dis Sci 2002; 47:2151–53.