Porter Ross J, McKinlay Alastair W, Metcalfe Emma L
Institute of Medical Sciences, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK.
Aberdeen Royal Infirmary Department of Digestive Disorders, NHS Grampian, Aberdeen, UK.
Frontline Gastroenterol. 2019 Nov 13;11(5):364-370. doi: 10.1136/flgastro-2019-101306. eCollection 2020.
Gastrostomy facilitates artificial enteral feeding but controversy exists around associated morbidity and mortality. This study aimed to report short and long-term outcomes, and identify parameters associated with overall survival.
A 7-year follow-up audit was undertaken at Aberdeen Royal Infirmary, UK. All patients undergoing endoscopic gastrostomy insertion October 2011-September 2018 were included. Last follow-up was February 2019. Clinical data were prospectively collected. Blood results were retrospectively obtained from electronic records. Statistical analysis was with IBM SPSS V.25.
691 procedures were performed over the 7-year period (520 traditional pull-through percutaneous endoscopic gastrostomy (PEG) and 171 gastropexy procedures to facilitate gastrostomy). Frequency of complications (gastrointestinal bleeding, perforation and peritonitis) was low (each n=1). Overall 7-day and 30-day mortality was 2.2% and 8.4%, respectively. One-year mortality reached 47.6%. There was no difference in survival between PEG and gastropexy procedures (p=0.410). Multivariate analysis reported increased age (p<0.001), increased alkaline phosphatase (p<0.001) and clinical indication (p=0.002) as independently associated with an increased hazard of death. Only age was moderately predictive of mortality (area under the curve 0.74, 95% CI 0.70 to 0.78, p<0.001) in the PEG group. Clinical indication was the only parameter independently associated with mortality in the gastropexy cohort (p=0.003).
Endoscopic gastrostomy placement can be safe with a low mortality and low risk of serious complications. Blood markers were not associated with short-term or long-term outcomes. Gastropexy to facilitate gastrostomy is a safe alternative to traditional pull-through PEG procedures. Future work should consider quality of life outcomes to assess the benefit of gastrostomy from a patient perspective.
胃造口术有助于人工肠内喂养，但围绕其相关的发病率和死亡率存在争议。本研究旨在报告短期和长期结果，并确定与总体生存相关的参数。
在英国阿伯丁皇家医院进行了为期7年的随访审计。纳入了2011年10月至2018年9月期间接受内镜下胃造口术插入的所有患者。最后一次随访时间为2019年2月。临床数据是前瞻性收集的。血液检查结果是从电子记录中回顾性获取的。使用IBM SPSS V.25进行统计分析。
在7年期间共进行了691例手术（520例传统经皮内镜下胃造口术（PEG）和171例用于辅助胃造口术的胃固定术）。并发症（胃肠道出血、穿孔和腹膜炎）的发生率较低（各n = 1）。总体7天和30天死亡率分别为2.2%和8.4%。1年死亡率达到47.6%。PEG和胃固定术之间的生存率没有差异（p = 0.410）。多变量分析报告年龄增加（p < 0.001）、碱性磷酸酶升高（p < 0.001）和临床指征（p = 0.002）与死亡风险增加独立相关。在PEG组中，只有年龄对死亡率有中度预测作用（曲线下面积0.74，95%CI 0.70至0.78，p < 0.001）。临床指征是胃固定术队列中与死亡率独立相关的唯一参数（p = 0.003）。
内镜下胃造口术放置可以是安全的，死亡率低且严重并发症风险低。血液标志物与短期或长期结果无关。用于辅助胃造口术的胃固定术是传统经皮内镜下胃造口术的安全替代方法。未来的工作应考虑生活质量结果，从患者角度评估胃造口术的益处。
