PWE-176 Trends in Gastrostomy Insertion Over a 10 Year Period. Are the Indications Changing?

Abstract

Introduction Gastrostomy insertion is a well accepted technique for enteral feeding however the most robust evidence is for patients with dysphagic stroke or head and neck cancer. Other indications for gastrostomy insertion have developed but the proportion of patients referred for each indication is not well documented. Our aim was to examine referral patterns for feeding tube insertion in our unit over the last ten years with reference to indication for tube insertion and type of tube inserted. Methods A retrospective review of all gastrostomy insertion was performed over the period May 2001 to December 2011 using the gastrostomy database. Data collected included patient demographics, indication for tube insertion and type of tube inserted (PEG, PEJ, PEG-j or gastropexy). Indication was divided into 5 main categories; stroke with dysphagia, head and neck cancer, neurological, dementia and other. Assessment of total number of each type of tube inserted per year and, for PEG alone, the total number of insertions per indication per year. Results During the study period 1387 tube insertions were carried out (1289 PEG, 41 PEJ, 32 PEG-j and 25 gastropexy). Over the ten year period there was a significant increase in the number of all types of tubes inserted (p < 0.001) with 65 PEG's alone inserted in 2001 rising to 129 PEG's, 7 PEJ, 4 PEG-j and 11 gastropexy's in 2011. In 2001 the proportion of patients having a PEG inserted by indication was stroke with dysphagia 26.2%, head and neck cancer 6.2%, neurological 35.4%, dementia 1.5% and other 10.8% (indication was not recorded in 20%). In 2011 the proportion of patients having a PEG inserted by indication was significantly different with stroke with dysphagia (22.5%), head and neck cancer (12.4%), neurological (37.2%), dementia (0.0%) and other 25.6% (indication was not recorded in 2.3%). The main differences were an increase in insertions in those with head and neck cancer and other indications. Conclusion In our centre, there has been a significant increase in the number and type of feeding tubes inserted over a decade. The proportion of patients having a PEG for the traditional indications such as stroke account for around one third of all insertions. PEG insertions for the miscellaneous indications have significantly increased suggesting that longer term nutritional support is being offered for a much broader range of conditions.