番茄社区

CHICAGO -- Centenarians who required percutaneous endoscopic gastrostomy (PEG) appeared to do as well with the tube placement, researchers reported here.

In-hospital mortality for the 30 patients over age 100 who were treated with PEG tube placement was 6.7% compared with 7.7% for the 275-patient control group (mean age 80.57), for an insignificant difference (P=1.0), according to Zain Sobani, MBBS, of Maimonides Medical Center in New York City, and colleagues.

"No major procedure-related complications were identified," Sobani told 番茄社区 at a Digestive Disease Week 2017 poster presentation. "Minor complications including mucosal injuries, dislodged tubes, post-procedure fever, minor bleeding, and superficial wound infections occurred more often in the centenarians." He added that these older patients tended to experience more fevers and also were more likely to pull the tubes out by themselves.

He explained that 13.3% of the centenarians experienced these complications compared with 2.9% of the relatively younger patients (P=0.022).

"Overall, what we are seeing is that it is pretty safe to do this in a 100-year-old patient," he said. "To date no study has looked into the safety of PEG tube placement in centenarian patients."

"We have a very vibrant older community in Brooklyn, and we a very aggressive about taking care of them," he said, adding that older patients are undergoing PEG tube placement more often because of increasing life expectancy. Studies have shown that procedure-related mortality, in-hospital mortality, and one month mortality is higher in older patients so "we wanted to see how our patients stacked up against what was in the literature," Sobani explained.

The authors reviewed outcomes among patients, ages 18 and up, who underwent PEG at Maimonides from July 2011 to June 2016. A random sample of 275 patients under the age of 100 who underwent the same procedure were selected as a control group, and that group ranged in age from 64 to 96.

Dysphagia and aspiration were the primary indications for 70% of the procedures, the authors noted. However, cancer patients were not included in the study population.

"These were patients who had strokes or were not able to maintain adequate food or water intake and they kept coming into the hospital because of dehydration." he explained. "This is a pseudo permanent treatment."

All PEG tubes were placed by an attending gastroenterologist with assistance from gastroenterology fellows. Sedation and airway were managed by an anesthesiologist.

Unsuccessful placement of the tubes occurred among 6.7% of the older patients compared with 2.6% of the younger group (P=0.222), translating to a 93.3% success in placing the tubes in the patients over age 100, and 97.4% success rate in the relatively younger cohort.

Sobani said that the in-patients mortality was due to the underlying disease states, but not due to the procedure.

"Percutaneous endoscopic gastrostomy may be safely attempted in carefully selected patients ages 100 or older," the authors wrote. "Age alone should not be an absolute contraindication to PEG placement. However, thoughtful patient selection and appropriate indication should always be practiced."

Comparing their findings with published data, Sobani said the findings from the current study fit well with general practice, and that his group reported a lower in-hospital mortality versus 9.5% in the literature.

Kondej Thanavachirasin, MD, of Loyola University Medical School, Oak Park, Ill., told 番茄社区 that "these results in patients over 100 are not surprising, if you are selecting the right patients for treatment." Thanavachirasin, who was not involved in the study, noted that other patients, such as those with cancer, may not be suitable candidates for PEG tube placement.

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