How long do percutaneous endoscopic gastrostomy feeding tubes last? A retrospective analysis.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes allow for long-term enteral feeding. Disk-retained PEG tubes may be suitable for long-term usage without planned replacement, but data on longevity are limited. We aimed to assess the rates and predictors of PEG longevity and post-PEG mortality. DESIGN: Single-centred retrospective cohort study of patients with disk-retained (Freka) PEG tubes. METHODS: All patients undergoing PEG between 2010 and 2013 were identified, and retrospective analysis of outcomes until 2017 (median 1062 days) was performed. Time-to-event data were plotted using Kaplan-Meier curves, with predictors of survival derived from multivariate Cox-regression analyses. RESULTS: 277patients were studied, with a median age of 74 years (IQR 59-82). PEG tube failure occurred in 17.4%, due to: buried bumper syndrome (7.0%), split/broken tube (6.3%), peristomal infection (1.8%) and dislodged tube (1.1%). PEG tube longevity was 95.1% (1 year) and 68.5% (5 year), with age <70 (HR 2.65, 95% CI 1.25 to 5.62, p=0.011) being predictive of PEG failure. Post-PEG mortality was 10.5% (30 day), 35.4% (1 year) and 59.7% (5 year). Age ≥70 was associated with mortality (HR 2.79, 95% CI 1.92 to 4.05, p<0.001), whereas PEG failure (HR 0.46, 95% CI 0.27 to 0.77, p=0.003) and elective PEG removal (HR 0.23, 95% CI 0.08 to 0.64, p=0.005) were associated with reduced mortality. CONCLUSIONS: 68.5% of PEG tubes remain intact after 5 years. Younger age was associated with earlier PEG failure, whereas younger age, PEG replacement and elective PEG tube removal were associated with improved survival. These data may inform future guidance for elective PEG tube replacements.

Intubation failure during gastroscopy: incidence, predictors and follow-up findings.

BACKGROUND: Intubation failure (IF) occurs when an endoscopist is unable to progress via the oropharynx into the upper oesophagus. AIM: To assess incidence and aetiology of IF and predictors of structural pharyngeal abnormalities in patients with IF. METHODS: All gastroscopies (n=26,130) performed in our centre, between August 2010 and August 2016 were retrospectively reviewed. Barium radiology and repeat gastroscopy findings were evaluated for structural causes of IF. Patients were categorised into 'failure to tolerate' and 'failure to progress' based on endoscopy reports. RESULTS: The incidence of IF was 0.95%. Rates of IF varied with endoscopist specialty (p=0.021), but not with patient age, sex or sedation dose. Among cases of IF, structural pharyngeal abnormalities were detected on barium radiology in 28.9%, consisting of cricopharyngeal hypertrophy and/or Zenker's diverticulum in 73.2%. 'Failure to progress' predicted pharyngeal pathology in 55.6%. Predictors of structural causes on barium radiology following IF included: age >/=65 (OR 4.0, 95% CI: 1.8-8.9, p<0.001); indication of dysphagia (OR 5.5, 95% CI: 2.5-11.8, p<0.001), and failure of endoscopic progression (OR 5.2, 95% CI: 2.3-12.0, p<0.001). CONCLUSION: Patients with IF should be investigated owing to the high risk of underlying pathology, particularly if associated with age >/=65, dysphagia, and failure of endoscopic progression. We propose that IF rates of <1% could be used as a quality indicator in gastroscopy.

The 2015 upper gastrointestinal "Be Clear on Cancer" campaign: its impact on gastroenterology services and malignant and premalignant diagnoses.

OBJECTIVE: To assess the impact of the upper gastrointestinal 'Be Clear on Cancer' campaign launched by Public Health England between January and February 2015 on open-access gastroscopy referrals, incidence of target diagnoses (oesophagogastric cancer and Barrett's oesophagus), cancer staging at presentation, 1-year survival and cost per additional diagnosis. DESIGN: We performed a retrospective study of patients referred for 2-week-wait (2WW), open-access endoscopy 3 months following the campaign with diagnoses, endoscopic findings, staging and 12-month survival compared with data from corresponding months in 2014. SETTING: Three adjacent National Health Service trusts in the West Midlands with a combined population of 1.34 million in 2015. RESULTS: 2WW open-access referrals increased by 48% (95% CI 1.35 to 1.61, p<0.001). The proportion of target diagnoses fell from 6.7% to 6.1% (p=0.62). There were no significant overall increases in target diagnoses (OR 1.35, 95% CI 0.95 to 1.92, p=0.11) or cancer (OR 1.30, 95% CI 0.80 to 2.07, p=0.36). There was no change in tumour, node, metastasis (TNM) staging for oesophageal or gastric cancer. Overall 1-year survival did not alter significantly (HR 1.10, 95% CI 0.56 to 2.19, p=0.76). DISCUSSION: The 'Be Clear on Cancer' campaign led to a 48% increase in demand for 2WW gastroscopies but did not significantly affect the incidence of target diagnoses, cancer staging or 1-year survival.