Prevalence and Trends in Percutaneous Endoscopic Gastrostomy Placement: Results From a 10-Year, Nationwide Analysis

Marcin Folwarski; Stanislaw Klek; Michał Brzeziński; Agnieszka Szlagatys-Sidorkiewicz; Adam Wyszomirski; Jarosław Meyer-Szary; Karolina Skonieczna-Żydecka

doi:10.3389/fnut.2022.906409

Prevalence and Trends in Percutaneous Endoscopic Gastrostomy Placement: Results From a 10-Year, Nationwide Analysis

Front Nutr. 2022 May 30:9:906409. doi: 10.3389/fnut.2022.906409. eCollection 2022.

Authors

Marcin Folwarski^{1

2}, Stanislaw Klek³, Michał Brzeziński⁴, Agnieszka Szlagatys-Sidorkiewicz⁴, Adam Wyszomirski⁵, Jarosław Meyer-Szary⁶, Karolina Skonieczna-Żydecka⁷

Affiliations

¹ Department of Clinical Nutrition and Dietetics, Medical University of Gdańsk, Gdańsk, Poland.
² General Surgery Department, Home Enteral and Parenteral Nutrition Unit, Nicolaus Copernicus Hospital, Gdańsk, Poland.
³ Surgical Oncology Clinic, Maria Skłodowska-Curie National Cancer Institute, Kraków, Poland.
⁴ Department of Pediatrics, Gastroenterology, Allergology, and Nutrition, Medical University of Gdańsk, Gdańsk, Poland.
⁵ Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
⁶ Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdańsk, Gdańsk, Poland.
⁷ Department of Biochemical Sciences, Pomeranian Medical University in Szczecin, Szczecin, Poland.

Abstract

Background: Percutaneous endoscopic gastrostomy (PEG) is the most commonly used access for long-term enteral nutrition. Only a few studies report the prevalence and epidemiology of PEG placements. No previous data concentrated on the healthcare system issues influencing the qualification rates and professional nutritional support for individuals with PEG.

Methods: We conducted a retrospective nationwide analysis of PEG placements in Poland from 2010 to 2020. The central data on ICD-10 coding of adult patients with PEG reported to the insurance company were used for the analysis of general and regional prevalence, age, and primary and secondary diseases. Rates of patients with home enteral nutrition (HEN) were calculated with a special focus on patients with cancer. A secondary aim was to determine the causes of regional disparities among administrative regions.

Results: A total number of 90,182 PEGs were placed during the observation period. The number was increasing each year with statistical significance. Malnutrition, dysphagia, and cardiorespiratory/metabolic diseases were the most frequently reported primary diseases. A total of 11.98% of all patients were diagnosed with cancer; 49.9% of oncological patients suffered from head and neck cancer (HNC) and 19.9% from esophageal cancer. In total, 6.61% of HNC and 27.46% of patients with esophageal cancer from the Polish National Cancer Registry (NCR) had PEG. The rates of patients in more advanced ages (65-74 and over 85 years) were growing and decreased in younger groups (18-24, 45-54, and 55-64 years). Overall, 27.6% of all (11.86% of cancer) patients with PEG were reimbursed HEN. A high number of patients in nursing care facilities, lower education of citizens, and lower number of hospital beds were associated with more PEG insertions in the administrative regions.

Conclusion: The number of PEG placements has been increasing, particularly in the elderly. Systemic solutions must be found to address the problems of regional disparities in PEG's prevalence as well as the lack of inclusion criteria for nutritional support.

Keywords: PEG; enteral nutrition; gastrostomy; head and neck cancer; home enteral nutrition.