Introduction Percutaneous endoscopic gastrostomy (PEG) feeding tubes are used when patients cannot maintain adequate nutrition with oral intake. This review aims to elucidate the number and nature of patient readmissions 8 days’ post PEG insertion at a major tertiary referral hospital, with a view to identify any areas for service improvement. Owing to its high mortality, a more detailed focus on 3 peritonitis cases has been highlighted.
Method 8 day readmission data was obtained for all new PEG insertions between 01-04-2011 and 31-10-2016 inclusive. Electronic and paper case notes were analysed to ascertain the reason for readmission and whether these were PEG related. A more detailed analysis was completed on 3 peritonitis cases, attempting to elucidate any factors that may have contributed to their occurrence.
There may have been other PEG related complications that resulted in a readmission after more than 8 days. Equally, patients who were never discharged between their PEG insertion and subsequent complication were not identified.
Results 18 PEG procedures, out of a total of 812, resulted in a readmission within 8 days (2.2%). These included both push (33.3%) and pull (66.6%) techniques. The table below displays the indication and complication of each readmission. 4 readmissions were deemed “innocent” patient concerns that could be attributed to trivial post-PEG symptoms.
3 peritonitis cases were identified (0.3%), all of which were to facilitate head and neck cancer treatment. Case 1 had a BMI of 40, underwent push PEG and was found to have suture dislodgement at laparotomy. Case 2 underwent pull PEG, had peritoneal leakage and was found to have a PEG sited through colonic mesentery into posterior stomach at laparotomy requiring repair. Case 3 underwent push PEG and experienced severe pain post-procedure resulting in early suture removal and subsequent presentation with PEG malposition in peritoneal space. No adverse factors concerning PEG insertion technique were identified.
Conclusion Peritonitis presenting as 8 day readmission remains a rare but serious complication following PEG insertion which seems to be largely unpreventable. Possible contributing factors may be high BMI and early suture removal. Severe post procedural pain should mandate immediate investigation to confirm position and robust pathways for aftercare and specialist review before discharge is advocated.
Disclosure of Interest None Declared
- Percutaneous Endoscopic Gastrostomy