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Nutritional Status and Quality of Life in Patients with Percutaneous Endoscopic Gastrostomy (PEG) in Practice: Prospective One-Year Follow-Up

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Abstract

Sixty patients (age 73 ± 14 years; 22 women, 38 men) with dysphagia (67% neurological diseases, 33% tumors) were followed up for 1 year after placement of a percutaneous endoscopic gastrostomy (PEG). Before PEG placement and at six appointments thereafter, the patients' nutritional status was measured using bioelectric impedance analysis (BIA) and hematological nutritional parameters. A validated questionnaire was used to assess quality of life (the Gastrointestinal Quality of Life Index, GIQLI). The overall mortality rate was 65%, and mortality during the hospitalization period was 22%. Depending on the duration of the dysphagia, marked nutritional deficits were observed at the start of the study (deficiencies in albumin in 49% of the patients, calcium in 15%, magnesium in 18%, retinol in 78%, α-tocopherol in 16%, folic acid in 16%, vitamin B12 in 8%, vitamin D in 40%, and zinc in 46%). With the exception of vitamin E, all parameters returned to normal during the follow-up period. At the start of the study, BIA indicated nutritional deficiency in 90% of the patients, with no overall improvement being observed during the follow-up period. The GIQLI scores, on average, reached a figure of 61% of an unrestricted quality of life. In conclusion, long-term nutrition via the PEG tube maintained the patients' quality of life. For BIA most patients were malnourished during the follow-up period, but nevertheless PEG feeding was enough to compensate for gross nutritional deficiencies. Not infrequently, the indication for PEG placement is established too late.

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References

  1. Pennington CR: Disease and malnutrition in British hospitals. Proc Nutr Soc 56:393-407, 1997

    Google Scholar 

  2. Gawenda M, Keller HW: Kosten und Finanzierung der künstlichen Ernährung. In HW Keller, M Gawenda (eds.). Ambulante künstliche Ernährung. Cologne, Pechstein, 1994, pp 51-55

    Google Scholar 

  3. Nehme AB: Nutritional support of hospitalized patient: the team concept. JAMA 243:1906, 1980

    Google Scholar 

  4. Fay DE, Poplausky M, Gruber M, Lance P. Long-term enteral feeding: a retrospective comparison of delivery via percutaneous endoscopic gastrostomy and nasoenteric tubes. Am J Gastroenterol 86:1604-1609, 1991

    Google Scholar 

  5. Noton B, Homer-Ward M, Donnelly MT, Long RG, Holmes GKT: A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. Br J Med 312:13-16, 1996

    Google Scholar 

  6. Ponsky JL, Gauderer MWL, Stellato TA: Percutaneous endoscopic gastrostomy: review of 150 cases. Arch Surg 118:913-914, 1983

    Google Scholar 

  7. Gauderer MWL, Ponsky JL, Izant RJ: Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15:872-875, 1980

    Google Scholar 

  8. Schapiro GD, Edmundowicz SA: Complications of percutaneous endoscopic gastrostomy. Gastrointest Endosc Clin N Am 6:409-422, 1996

    Google Scholar 

  9. Bleck JS, Reiss B, Gebel M, Wagner S, Strassburg CP, Meier PN, Boozari B, Schneider A, Caselitz M, Westhoff-Bleck M, Manns M: Percutaneous sonographic gastrostomy: method, indications, and problems. Am J Gastroenterol 93:941-945, 1998

    Google Scholar 

  10. Löser C, Wolters S, Fölsch UR: Enteral long-term nutrition via endoscopic gastrostomy (PEG) in 210 patients: a four-year prospective study. Dig Dis Sci 43:2549-2557, 1998

    Google Scholar 

  11. Eypasch E, Wood-Dauphinée S, Williams JI, Ure B, Neugebauer E, Troidl H: Der Gastrointestinale Lebensqualitätsindex (GLQI)—Ein klinimetrischer Index zur Befindlichkeitsmessung in der gastroenterologischen Chirurgie. Chirurg 64:264-274, 1993

    Google Scholar 

  12. Preclik G, Grüne S, Leser HG, Lebherz J, Heldwein W, Machka W, Holstege A, Kern WV: Prospective, randomised, double blind trial of prophylaxis with single dose of co-amoxiclav before percutaneous endoscopic gastrostomy. BMJ 319:881-884, 1999

    Google Scholar 

  13. Choudhry U, Barde CJ, Markert R, Gopalswamy N: Percutaneous endoscopic gastrostomy: a randomized prospective comparison of early and delayed feeding. Gastrointest Endosc 44:164-167, 1996

    Google Scholar 

  14. Chumlea WC, Guo SS: Bioelectrical impedance and body composition: present status and future directions. Nutr Rev 53:123-131, 1994

    Google Scholar 

  15. Pencharz PB, Azcue M: Use of bioelectrical impedance analysis measurements in the clinical management of nutrition. Am J Clin Nutr 64(suppl):485S-488S, 1996

    Google Scholar 

  16. Segal KR, Burastero S, Chun A, Coronel P, Pierson RN, Wang J: Estimation of extracellular and total body water by multiple-frequency bioelectrical impedance measurement. Am J Clin Nutr 54:26-29, 1991

    Google Scholar 

  17. Shizgal HM: Body composition of patients with malnutrition and cancer. Cancer 55:250-253, 1985

    Google Scholar 

  18. Fischer H, Lembecke B: Die Anwendung der bioelektrischen Impedanzanalyse (BIA) zur Beurteilung der Körperzusammensetzung und des Ernährungszustandes. Inn Med 18:13-17, 1991

    Google Scholar 

  19. Finocchiaro C, Galleti R, Rovera G, Ferrari A, Todros L, Vuolo A, Balzola F: Percutaneous endoscopic gastrostomy: a long-term follow up. Nutrition 13:520-523, 1997

    Google Scholar 

  20. Larson DE, Burton DD, Schroeder KW, Dimagno EP: Percutaneous endoscopic gastrostomy: indication, success, complication and mortality in 314 consecutive patients. Gastroenterology 93:48-52, 1987

    Google Scholar 

  21. Taylor CA, Larson DE, Ballard DJ, Bergstrom LR, Silverstein MD, Zinsmeister AR, DiMagno EP: Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study. Mayo Clin Proc 67:1042-1049, 1992

    Google Scholar 

  22. Callahan CM, Haag KM, Weinburger MW: Outcomes for percutaneous gastrostomy among older adults in a community setting. J Am Geriatr Soc 48:1048-1054, 2000

    Google Scholar 

  23. Kaw M, Sekas G: Long-term follow-up of consequences of percutaneous gastrostomy (PEG) tubes in nursing home patients. Dig Dis Sci 39:738-743, 1994

    Google Scholar 

  24. Grant MD, Rudberg MA, Brody JA: Gastrostomy placement and mortality among hospitalized Medicare beneficiaries. JAMA 279:1973-1976, 1998

    Google Scholar 

  25. Rabeneck L, Wary NP, Petersen NJ: Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes. J Gen Intern Med 11:287-293, 1996

    Google Scholar 

  26. American Sociaty for Gastrointestinal Endoscopy: Role of PEG/PEJ in enteral feeding. Gastrointest Endosc 48:699-701, 1998

    Google Scholar 

  27. Kirby DF, De Legge MH, Fleming CR: American Gastroenterology Association technical review on tube feeding for enteral nutrition. Gastroenterology 108:1282-1301, 1995

    Google Scholar 

  28. Rabeneck L, McCullough LB, Wary NP: Ethically justified, clinically comprehensive guidelines for percutaneous endoscopic gastrostomy tube placement. Lancet 349:496-498, 1997

    Google Scholar 

  29. Sanders DS, Carter MJ, D'Silva J, McAlindon ME, Willemse PJ, Bradham KD: Percutaneous endoscopic gastrostomy: a prospective analysis of hospital support required and complications following discharge to community. Eur J Clin Nutr 55:610-614, 2001

    Google Scholar 

  30. Ciocon JO, Silverstone FA, Graver LM, Foley CJ: Tube feedings in elderly patients: indications, benefits and complications. Arch Intern Med 148:429-433, 1988

    Google Scholar 

  31. Lee JH, Machtay M, Unger LD: Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch Otolaryngol Head Neck Surg 124:871-875, 1998

    Google Scholar 

  32. Ockenga J, Süttmann U, Selber O, Schlesinger A, Meier PN, Gebel M, Schedel I, Deicher H: Percutaneous endoscopic gastrostomy in AIDS and control patients: risks and outcome. Am J Gastroenterol 92:1817-1822, 1996

    Google Scholar 

  33. Friedenberg F, Jensen G, Gujral N, Braitman LE, Levine GM: Serum albumin is predictive of 30-day survival after percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr 21:72-74, 1997

    Google Scholar 

  34. Bannerman E, Pendlebury J, Phillips F, Ghosh S: A cross-sectional and longitudinal study of health-related quality of life after percutaneous gastrostomy. Eur J Gastroenterol Hepatol 12:1101-1109, 2000

    Google Scholar 

  35. Weaver JP, Odell P, Nelson C: Evaluation of the benefits of gastric tube feeding in an elderly population. Arch Fam Med 2:953-956, 1993

    Google Scholar 

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Authors and Affiliations

  1. The Ludwig Maximilian University, Munich

    Joachim Klose, Walter Heldwein, Michael Rafferzeder, Frederike Sernetz, Manfred Gross & Klaus Loeschke

  2. Department of Medicine, City Center Hospital, Munich, Germany

    Joachim Klose, Walter Heldwein, Michael Rafferzeder, Frederike Sernetz, Manfred Gross & Klaus Loeschke

Authors
  1. Joachim Klose
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  2. Walter Heldwein
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  3. Michael Rafferzeder
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  4. Frederike Sernetz
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  5. Manfred Gross
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  6. Klaus Loeschke
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Correspondence to Joachim Klose.

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Klose, J., Heldwein, W., Rafferzeder, M. et al. Nutritional Status and Quality of Life in Patients with Percutaneous Endoscopic Gastrostomy (PEG) in Practice: Prospective One-Year Follow-Up. Dig Dis Sci 48, 2057–2063 (2003). https://doi.org/10.1023/A:1026199110891

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