P2505 - Characteristics and Outcomes of Patients Consulted for Percutaneous Endoscopic Gastrostomy Tubes During the COVID-19 Pandemic: A Multicenter Experience

Anthony Choi, MD¹, Preston Atteberry, MD¹, Rachel Engelberg, MD¹, Tracey Martin, MD², Adam P. Buckholz, MD³, Rachel Niec, MD, PhD¹, Kaveh Hajifathalian, MD¹, Reem Sharaiha, MD, MSc², Carolyn Newberry, MD¹, AnnMarie Kieber-Emmons, MD, MS⁴, David Wan, MD^5
1New York-Presbyterian/Weill Cornell Medical Center, New York, NY; ²Weill Cornell Medical College, New York, NY; ³New York Presbyterian/Weill Cornell Medical College, New York, NY; ⁴Weill Cornell New York Presbyterian, New York, NY; ⁵New York Presbyterian Weill Cornell Medicine, New York, NY

Introduction: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, can result in critical illness and an unprecedented burden on the healthcare system. Severe cases can lead to prolonged hospitalizations, intubations and tracheostomy placements necessitating longer term nutrition planning including placement of percutaneous endoscopic gastrostomy (PEG) tubes. However, major uncertainties surround PEG tube placement in patients with COVID-19, including resources, exposure, and most importantly, the natural history of the disease, which we attempt to address through this study.

Methods: We retrospectively analyzed all patients seen in consultation for PEG tube placement at two hospitals in New York City, considered an epicenter of the COVID-19 pandemic, between March 20, 2020 and May 15, 2020.

Results: We identified 41 consecutive inpatients who were COVID+ and whose primary team consulted gastroenterology for PEG tube placement. The GI service placed PEG tubes in 24 patients (PEG cohort), and deferred placement in 17 others (noPEG cohort). Patients in the PEG cohort had higher Sheffield gastrostomy scores, Charlson comorbidity indices, and NUTRIC scores. Twelve of 41 (29%) of all consulted patients eventually tolerated per os (PO) intake by time of discharge/analysis, involving 53% of the noPEG cohort versus 13% of the PEG cohort (p=0.016). Average time from tracheostomy to PEG placement and from GI consult to PEG placement was 14±9 days and 3±3 days, respectively. PEG-related complications included bleeding (2), dislodgement (1), and colonic perforation (1).

Discussion: As many patients infected with COVID-19 become critically ill and develop prolonged hospitalizations, providing enteral feeding access via PEG tube placement is an increasingly common request. Some patients who were consulted for PEG tube were able to resume PO intake, and there were even requests to remove PEGs that were placed during the same hospitalization. While PEG tubes are generally safe, complications can occur, and careful selection of patients is essential to avoid unnecessary morbidity.

	PEG (n=24)	noPEG (n=17)	P-value
Age*	73.6±9.6	64.2±13.6	0.016
Female	10 (42%)	8 (47%)	0.732
BMI	26.5±5	25.5±5.3	0.554
Charlson comorbidity index*	3.9±1.8	2.4±2.3	0.020
Sheffield score*	2.5±0.7	1.9±1	0.045
NUTRIC score	4±2.1	3.1±2.2	0.178
COVID+ on last test prior to endoscopy	12 (50%)	13 (76%)	0.343
Anticoagulation administration periprocedure	21 (88%)	17 (100%)	0.362
Steroid administration periprocedure	3 (13%)	4 (25%)	0.343
Albumin (g/dL) periprocedure	2.1±0.8	2.5±0.6	0.057
SLP evaluation before GI consult	5 (21%)	8 (47%)	0.075
Palliative care evaluation before GI consult	13 (54%)	7 (41%)	0.476
Nutrition evaluation before GI consult	20 (83%)	14 (82%)	0.166
Tracheostomy placement before GI consult	16 (67%)	7 (41%)	0.098
NGT/OGT before GI consult	23 (96%)	15 (88%)	0.646
Disposition (Home/SNF/still admitted)	4%/29%/67%	12%/29%/59%	0.643
Gastrostomy tube placed by other service?	0 (0%)	5 (29%)	NA
Intubation/mechanical ventilation?	19 (79%)	12 (71%)	0.757
Duration of intubation/mechanical ventilation, days	19±11	27±15	0.257
Duration of OGT/NGT, days	29±11	32±20	0.948
Tolerating PO intake before discharge*	3 (13%)	9 (53%)	0.016

Table: Table 1. Characteristics comparing COVID+ patients who had PEG tube placed by GI (PEG cohort) vs not placed by GI (noPEG cohort)
*p = < 0.05
COVID+: positive for SARS-CoV-2 by nasopharyngeal swab; PEG: percutaneous endoscopic gastrostomy; GI: gastroenterology; BMI: body mass index; NUTRIC: nutrition risk in critically ill; SLP: speech-language pathology; NGT: nasogastric tube; OGT: orogastric tube; SNF: skilled nursing facility; PO: per os



Disclosures:
Anthony Choi indicated no relevant financial relationships.
Preston Atteberry indicated no relevant financial relationships.
Rachel Engelberg indicated no relevant financial relationships.
Tracey Martin indicated no relevant financial relationships.
Adam Buckholz indicated no relevant financial relationships.
Rachel Niec indicated no relevant financial relationships.
Kaveh Hajifathalian indicated no relevant financial relationships.
Reem Sharaiha indicated no relevant financial relationships.
Carolyn Newberry indicated no relevant financial relationships.
AnnMarie Kieber-Emmons indicated no relevant financial relationships.
David Wan indicated no relevant financial relationships.


Anthony Choi, MD¹, Preston Atteberry, MD¹, Rachel Engelberg, MD¹, Tracey Martin, MD², Adam P. Buckholz, MD³, Rachel Niec, MD, PhD¹, Kaveh Hajifathalian, MD¹, Reem Sharaiha, MD, MSc², Carolyn Newberry, MD¹, AnnMarie Kieber-Emmons, MD, MS⁴, David Wan, MD⁵. P2505 - Characteristics and Outcomes of Patients Consulted for Percutaneous Endoscopic Gastrostomy Tubes During the COVID-19 Pandemic: A Multicenter Experience, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.