Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden.
World J Gastroenterol. 2024 Mar 14;30(10):1358-1367. doi: 10.3748/wjg.v30.i10.1358.
Percutaneous endoscopic gastrostomy (PEG) and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children, respectively, requiring long-term enteral nutrition support. Procedure-related mortality is a rare event, often reported to be zero in smaller studies. National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature.
To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term (< 30 d) and long-term survival.
In this retrospective, population-based cohort study, individuals that had received a gastrostomy between 1998-2019 in Sweden were included. Individuals were identified in the Swedish National Patient Register, and survival analysis was possible by cross-referencing the Swedish Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). Kaplan-Meier with log-rank test and Cox regression were used for survival analysis.
In total 48682 individuals (52% males, average age 60.9 ± 25.3 years) were identified. The cohort consisted of 12.0% children, 29.5% adults, and 58.5% elderly. An increased use of gastrostomies was observed during the study period, from 13.7/100000 to 22.3/100000 individuals ( < 0.001). The use of PEG more than doubled (about 800 to 1800/year), with a corresponding decrease in open gastrostomy (about 700 to 340/year). Laparoscopic gastrostomy increased more than ten-fold (about 20 to 240/year). Overall, PEG, open gastrostomy, and laparoscopic gastrostomy constituted 70.0% ( = 34060), 23.3% ( = 11336), and 4.9% ( = 2404), respectively. Procedure-related mortality was 0.1% ( = 44) overall (PEG: 0.05%, open: 0.24%, laparoscopic: 0.04%). The overall 30-d mortality rate was 10.0% (PEG: 9.8%, open: 12.4%, laparoscopic: 1.7%) and decreased from 11.6% in 1998-2009 8.5% in 2010-2019 ( < 0.001). One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases.
The annual use of gastrostomies in Sweden increased during the study period, with a shift towards more minimally invasive procedures. Although procedure-related death was rare, the overall 30-d mortality rate was high (10%). To overcome this, we believe that patient selection should be improved.
经皮内镜下胃造口术（PEG）和腹腔镜下胃造口术分别已成为成人患者和儿童患者长期肠内营养支持的金标准。与该操作相关的死亡率是一种罕见的事件，在较小的研究中通常报告为零。关于接受胃造口术患者的 30 天死亡率和长期生存率的全国性数据在文献中很少见。
研究瑞典从 1998 年至 2019 年期间胃造口术的使用情况，并分析与操作相关的死亡率以及短期（<30 天）和长期生存率。
在这项回顾性、基于人群的队列研究中，纳入了 1998 年至 2019 年期间在瑞典接受胃造口术的个体。通过瑞典国家患者登记处确定个体，并通过交叉参考瑞典死亡登记处进行生存分析。该队列分为三个年龄组：儿童（0-18 岁）；成年人（19-64 岁）；和老年人（≥65 岁）。使用 Kaplan-Meier 对数秩检验和 Cox 回归进行生存分析。
共确定了 48682 名个体（52%为男性，平均年龄为 60.9±25.3 岁）。该队列包括 12.0%的儿童、29.5%的成年人和 58.5%的老年人。在研究期间，胃造口术的使用呈增加趋势，从 13.7/100000 增加到 22.3/100000 个人（<0.001）。PEG 的使用增加了一倍以上（约 800 到 1800/年），而开放性胃造口术的使用则相应减少（约 700 到 340/年）。腹腔镜胃造口术增加了十倍以上（约 20 到 240/年）。总体而言，PEG、开放性胃造口术和腹腔镜胃造口术分别占 70.0%（=34060）、23.3%（=11336）和 4.9%（=2404）。与操作相关的死亡率总体为 0.1%（=44）（PEG：0.05%，开放性：0.24%，腹腔镜：0.04%）。总体 30 天死亡率为 10.0%（PEG：9.8%，开放性：12.4%，腹腔镜：1.7%），从 1998-2009 年的 11.6%下降到 2010-2019 年的 8.5%（<0.001）。儿童、成年人和老年人的一年和十年生存率分别为 93.7%、67.5%和 42.1%和 79.9%、39.2%和 6.8%。死亡的最常见原因是恶性肿瘤以及心血管和呼吸系统疾病。
在研究期间，瑞典胃造口术的年使用率增加，微创手术的使用率也有所增加。尽管与操作相关的死亡率较低，但总体 30 天死亡率仍很高（10%）。为了克服这一问题，我们认为应改善患者选择。
