Arshish Dua, MD1, Rizwan Mahmood, MD1, Camille Kezer, MD2, Judy Trieu, MD, MPH1, Amy Wozniak3, Mukund Venu, MD, FACG1, Abdul Haseeb, MD, MPH1, Peter Sargon, MD1, Nikhil Shastri, MD1, Neil Gupta, MD, MPH1; 1Loyola University Medical Center, Maywood, IL; 2Mayo Clinic, Rochester, MN; 3Loyola University of Chicago, Maywood, IL
Introduction: Gastrointestinal perforation is a significant risk in almost all endoscopic procedures. Tube dislodgement is unique to percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) placement. We assessed associated risks of PEG and PEG-J tube PD in all patients (pts) as well as those with malignancy who received chemotherapy. Methods: 509 pts identified by diagnostic codes for initial attempt at PEG or PEG-J tube placement from 2012-2017 were retrospectively reviewed. 29 pts were excluded from analysis due to aborted procedures and lack of outcome data.Fig1 PD related complications were defined as radiographical, endoscopic, or surgically confirmed perforation or frank tube migration requiring medical or procedural intervention within 6 months from procedure date. As only 3 perforations occurred with 2 having concurrent tube dislodgements, PD was considered as a composite outcome in analysis. Initial chemo, demographic characteristics, maneuver type, tube size, antiplatelet or anticoagulant use (AAU), malignancy status, baseline proton pump inhibitor (PPI) and histamine receptor 2 antagonist (H2RA) use, body mass index (BMI), diabetes status, and albumin levels were collected.Table1 Univariate and multivariate models were used to assess association of risk factors with PD outcome of interest Results: Of the 480 pts in the study, 22 (4.6%) developed tube dislodgement with 3 (0.6%) suffering perforation. Median time to PD was 22 days (IQR 7-52). 73 (15%) specifically underwent PEG-J placement. Over half the study population (56%) had malignancy and 167 (33%) received chemotherapy. 1 of 3 perforations occurred at time of procedure and 1 of 3 perforations involved PEG-J placement. Age ≥ 70, tube size (≤20 Fr vs >20 Fr), baseline malignancy, PPI/H2RA use, AAU, albumin < 3, and BMI < 18 or >30 did not increase risk of PD on univariate analysis.Table2 Chemotherapy within 30 days prior to 15 days after the procedure did not increase odds of PD on univariate (0.642, CI 0.14-2.81, p< 0.55) or multivariate analysis (OR 0.789, CI 0.17-3.56, p< 0.75) while PEG-J procedures increased risk of PD in both (OR 3.94, CI 1.64-9.49 p< .0022 and OR 3.81, CI 1.55-9.33 p< .0034, respectively).Table2 Discussion: PD incidence in percutaneous endoscopic enteral tube placement is not influenced by chemotherapy administration even when given in the periprocedural period. PD remains higher in PEG-J procedures and is primarily related to jejunal extension malfunction.