Guidelines for identification and management of outpatient percutaneous endoscopic gastrostomy tube placement

IntroductionWe sought to determine if percutaneous endoscopic gastrostomy (PEG) could be safely performed in an outpatient fashion.MethodsOne hundred consecutive inpatient (IP) and outpatient (OP) PEGs were analyzed. Patient demographics, PEG indication, nutritional status, complications, and 30-day mortality were determined. Data were analyzed with Student t tests (STTs) and Fisher exact tests (FETs). All OP PEG candidates were evaluated by our dietician, and postprocedure management was discussed before PEG placement.ResultsSeventy-four IP and 26 OP PEGs were attempted. All OP PEGs were placed for head and neck cancers, whereas only 18 of 74 (24%) of IP PEGs were performed for that reason (P < .0001 by FET). Mean pre-PEG albumin levels in OP patients were 3.86 g/dL versus 2.79 g/dL for IP patients (P < .0001 by STT). No differences were found in complication rates (OP vs IP, P = .56 by FET). Thirty-day mortality for OP patients was 0% and 9.5% for IP patients.DiscussionOP PEG placement is safe and feasible in carefully selected patients. It requires a care path–driven team approach.