Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA.
Dig Dis Sci. 2013 Mar;58(3):768-76. doi: 10.1007/s10620-012-2397-8. Epub 2012 Sep 25.
Cancer patients benefit from percutaneous endoscopic gastrostomy (PEG) in many ways including nutritional support and venting in cases of malignant obstruction. Lack of high-quality studies with adequate follow-up has led to limited information regarding risk stratification and predictors of morbidity and mortality.
Elucidate predictors of complications and mortality with long-term follow-up in cancer patients undergoing PEG.
Retrospective review of all patients undergoing PEG placement at MD Anderson Cancer Center from January 1, 2004 to December 31, 2006. Statistical analysis included descriptive statistics, Kaplan-Meier survival estimates, and Cox proportional hazards regression analyses.
A total of 218 subjects underwent PEG. Those with American Society of Anesthesiology (ASA) scores of 4, 4E, or 5E were at significant risk of a major complication in the first 30 days. Multivariate analysis revealed ASA scores ≥4, elevated WBC count, and advanced tumor stage to be independent predictors of mortality in the first 30 days and INR >1.5 and diversion/venting as an indication for PEG placement to be independent predictors of overall mortality.
Patients with high baseline illness severity are more likely to have complications and are at increased risk of mortality after PEG. Our study results suggest that particular attention be directed to ASA score, INR, WBC counts, transfusion requirements, presence of advanced malignancies, and the indication for PEG placement when determining risk of complications or death. Patients undergoing venting PEG are expected to have short post-PEG survival but improvement in quality of life likely justifies the risks associated with PEG placement.
癌症患者从经皮内镜胃造口术（PEG）中获益良多，包括营养支持和恶性梗阻时的引流。由于缺乏高质量、随访充分的研究，有关发病率和死亡率的风险分层和预测因素的信息有限。
阐明在接受 PEG 的癌症患者中，通过长期随访预测并发症和死亡率的因素。
回顾性分析 2004 年 1 月 1 日至 2006 年 12 月 31 日期间在 MD 安德森癌症中心接受 PEG 置管的所有患者。统计分析包括描述性统计、Kaplan-Meier 生存估计和 Cox 比例风险回归分析。
共有 218 名患者接受了 PEG。ASA 评分 4、4E 或 5E 的患者在术后 30 天内发生重大并发症的风险显著增加。多变量分析显示，ASA 评分≥4、白细胞计数升高和晚期肿瘤分期是术后 30 天内死亡的独立预测因素，INR>1.5 和引流/通气是 PEG 置管的独立预测因素。
基线疾病严重程度较高的患者更有可能发生并发症，并且在接受 PEG 后死亡风险增加。我们的研究结果表明，在确定并发症或死亡风险时，应特别注意 ASA 评分、INR、白细胞计数、输血需求、晚期恶性肿瘤的存在以及 PEG 置管的指征。接受通气 PEG 的患者术后生存时间较短，但生活质量的改善可能证明 PEG 置管相关风险是合理的。
