Elective home replacement of gastrostomy feeding tubes is safe and cost-effective. Has hospital referral become obsolete?

Abstract

Background: Percutaneous endoscopic gastrostomy (PEG) is the technique of choice for providing enteral nutrition in patients with functioning gastrointestinal tract. Available guidelines cover indications and procedural management for PEG placement, while there is no consensus about subsequent replacement with gastrostomy feeding tubes (GFT) and their management. We hypothesized that GFT replacement, according to a standardized protocol supervised by a trained gastroenterologist could be integrated into the home health care system.

Aims: To evaluate the safety and cost-efficacy of home GFT replacement.

Methods: All consecutive patients who underwent elective home GFT replacements from July 2016 to December 2019 were prospectively enrolled; all procedural details and outcomes have been recorded.

Results: Overall, 235 GFT replacements in 84 patients [40.5% male, 79.5 (74-94) years] were included. Among these, 230 (97.8%) were completed at patients' home while in five cases (2.2%) patients were referred to the hospital to confirm appropriate GFT placement. No adverse event occurred. An overall cost reduction of 46.8% was obtained, leading to €124 savings per procedure and up to €29,000 savings for the entire study period.

Conclusions: When performed electively according to a standardized protocol, home GFT replacement is safe and effective, and leads to relevant cost reduction.

Keywords: Enteral feeding; Healthcare; Home replacement; Percutaneous endoscopic gastrostomy; Protocol.