Introduction Nottingham University Hospitals (NUH) NHS Trust serves as a tertiary centre for Gastroenterology, Stroke, Neurosurgery and Oncology. Our current practice for vetting referrals differs for PEG and RIG. PEG requests are forwarded to the Nutrition Team for vetting. RIG referrals are sent directly to Radiology for vetting. Our Specialist Nutrition nurses provide a robust assessment including clinical assessment, dietician and speech and language therapy review. Complex cases are discussed with a Gastroenterologist. Pre-procedure review of RIG patients may be undertaken by any physician.
Methods We retrospectively reviewed all PEG and RIG referrals from 2012. The nutrition records, case notes and electronic records were reviewed. We collected data on referring specialty, indication and 30-day complication and mortality rates. Data was collated onto a database for analysis.
Results 329 referrals were received; 148 for PEG and 181 for RIG. Of these, 76 (51.4%) were deemed appropriate for PEG and 168 (92.8%) for RIG. Reasons for refusal included patient fitness, meeting nutritional needs, suitable for alternative method of feeding or unsuitable for anatomical/technical reasons. Main service users were Stroke and Neurology, other medical specialties, Clinical Oncology, Neurosurgery and Ear, Nose and Throat. Indications included intracranial events, head and neck cancers and dysphagia secondary to gastroenterological, neuromuscular or neurodegenerative conditions.
30-day complications: Stoma site infections; (15.8% for PEG and 19.6% for RIG), chest infections; (6.58% for PEG and 6.55% for RIG) and minor complications (including blocked or dislodged tube); (5.26% for PEG and 11.9% for RIG). Major complications were low (0% for PEG and 2.97% RIG - including perforation (0.60%), respiratory arrest (0.60%), desaturation (0.60%) and pneumoperitoneum (1.19%)). 30-day all-cause mortality was 6.58% (PEG) and 8.33% (RIG).
Conclusion Pre-screening PEG referrals identified more inappropriate cases than those referred for RIG. With the exception of chest infections, 30 day minor and major complications were lower in the PEG group, as was 30-day all-cause mortality. We hypothesise that the less rigorous screening process may be contributing to excess complication and mortality rates of RIG insertion. This may, or may not be unique to our Trust. RIG is usually the second line method of insertion, and we recognise that this patient group may have a poorer premorbid state. We recommend formal assessment of all gastrostomy referrals regardless of insertion technique. The Nutrition Team is currently looking towards pre-screening all gastrostomy referrals.
Disclosure of Interest None Declared.
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