Size does matter: clinical outcomes of percutaneous endoscopic gastrostomy (PEG) placement in a South African tertiary endoscopy unit

Abstract

Background: Enteral access is considered the most physiological and beneficial feeding route. Percutaneous endoscopic gastrostomy (PEG) is widely used for enteral feeding in patients with functional gastrointestinal systems, but who are unable to maintain sufficient oral intake to meet daily nutritional and metabolic needs. PEG-related complications can be significant, but reported rates are variable.
Aim: To investigate the use, complications, and outcomes associated with PEG insertion in a South African tertiary-level centre.
Methods: Retrospective study including all patients who underwent PEG insertion at the Groote Schuur Hospital Gastroenterology Unit between March 2018 and June 2023. Variables obtained included patient demographics, comorbidities, PEG insertion details, and complications.
Results: A total of 149 patients undergoing 158 PEG-insertion procedures were included with a median age of 54 years (IQR: 38–64) with the majority being male (91; 61.1%). The most common indication for PEG insertion was cerebrovascular accident (CVA) at 25.5%. PEG-related complications were divided into three: insertion-related, early (within 30 days of insertion), and late (after 30 days of insertion) and observed in 64 patients (43.0%). The only factor found to be associated with an increased early complication rate was the size of the PEG, with 24Fr tubes having a higher complication rate compared with smaller tubes (25.5% vs. 3.7%, p < 0.001).
Conclusions: Local indications and high complication rates of PEG placement are highlighted, advocating for the judicial placement of PEGs. Early complications are notably higher with increased diameter tubing, and it is recommended that the use of 24Fr tubes be avoided if possible.

Keywords: complication rate, enteral feeding, outcomes, percutaneous endoscopic gastrostomy