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Is Percutaneous Endoscopic Gastrostomy A Solution for Aspiration Pneumonia, or Just An Illusion?
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Abstract
Background/Aims: Aspiration pneumonia is a pulmonary infection that occurs when food, liquid, saliva, or vomit is aspirated into the lungs. Percutaneous enteral gastrostomy (PEG) prevents aspiration pneumonia while ensuring the patient receives adequate nutrition. The authors aimed to evaluate the incidence and risk factors of post-PEG aspiration pneumonia.
Materials and Methods: Elderly patients who underwent PEG between January 2019 and December 2023 were included in this retro- spective study. The incidence of aspiration pneumonia was compared between the periods before and after PEG. Mortality rates and risk factors of post-PEG aspiration pneumonia were investigated.
Results: A total of 430 out of 534 patients who underwent PEG were included. The aspiration pneumonia rate was 30.1% (n = 133) before PEG and 21.9% (n = 94) after PEG (P = .003). The 1-year mortality rate of post-PEG aspiration pneumonia was 58.5% (n = 55). Age ≥ 80 years (OR: 3.11; 95% CI, 1.12-8.76), home residency (OR: 3.31; 95% CI, 0.99-10.8), discontinuation of primary caregiver who had been trained about PEG (OR: 5.8; 95% CI, 1.4-25.2), chronic lung disease (OR: 3.016; 95% CI, 1.17-7.77), history of recurrent aspiration pneumonia prior to PEG (OR: 3.401; 95% CI, 1.073-10.779), spending ≥20 hours of the day in supine position (OR: 6.512; 95% CI, 1.879-28.103), requiring PEG due to stroke (OR: 2.46; 95% CI, 1.062-5.69), and esophagus cancer (OR: 3.047; 95% CI, 1.174-8.88) were associated with post-PEG aspiration pneumonia.
Conclusion: Percutaneous enteral gastrostomy reduces aspiration pneumonia in general, but there remain risks, particularly in patients with stroke or esophageal cancer. Supine position and discontinuation of primary caregiver who had been trained about PEG are major risk factors.
Cite this article as: Yüksel A, Esendağlı D, Nezalzova P, Ulubay G. Is percutaneous endoscopic gastrostomy a solution for aspiration pneumonia, or just an illusion?. Turk J Gastroenterol. Published online March 28, 2025. doi 10.5152/tjg.2025.24632.
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References
1. Teramoto S. The current definition, epidemiology, animal models and a novel therapeutic strategy for aspiration pneumonia. Respir Investig. 2022;60(1):45-55. [CrossRef]
2. Sanivarapu RR, Vaqar S, Gibson J. Aspiration pneumonia. National Library of Medicine. National Center for Biotechnology Information. 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470459/. Last Update: March 20, 2024.
3. Fernández-Sabé N, Carratalà J, Rosón B, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine. 2003;82(3):159-169. [CrossRef]
4. Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing. 2010;39(1):39-45. [CrossRef]
5. Ko JY, Shin DY, Kim TU, Kim SY, Hyun JK, Lee SJ. Predictors of aspiration pneumonia in the elderly with swallowing dysfunction: videofluoroscopic swallowing study. Ann Rehabil Med. 2021;45(2):99-107. [CrossRef]
6. Fugazza A, Capogreco A, Cappello A, et al. Percutaneous endoscopic gastrostomy and jejunostomy: indications and techniques. World J Gastrointest Endosc. 2022;14(5):250-266. [CrossRef]
7. Du G, Liu F, Ma X, et al. Comparison between percutaneous endoscopic gastrostomy and nasogastric feeding in 160 patients with swallowing disturbances: a two-year follow-up study. Clin Interv Aging. 2022;17:1803-1810. [CrossRef]
8. Binicier ÖB, Soytürk M, Bengi G, et al. Indications, complications, and patient satisfaction in percutaneous endoscopic gastrostomy. Turk Klin J Gastroenterohepatol. 2010;17(1):9-16.
9. Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol. 2012;47(6):737-742. [CrossRef]
10. Kitamura T, Nakase H, Iizuka H. Risk factors for aspiration pneumonia after percutaneous endoscopic gastrostomy. Gerontology. 2007;53(4):224-227. [CrossRef]
11. Ticinesi A, Nouvenne A, Lauretani F, et al. Survival in older adults with dementia and eating problems: to PEG or not to PEG? Clin Nutr. 2016;35(6):1512-1516. [CrossRef]
12. Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med. 1994;150(1):251-253. [CrossRef]
13. Langmore SE, Terpenning MS, Schork A, et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13(2):69-81. [CrossRef]
14. Teramoto S, Fukuchi Y, Sasaki H, et al. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in older patients: a multicenter, prospective study in Japan. J Am Geriatr Soc. 2008;56(3):577-579. [CrossRef]
15. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665-671. [CrossRef]
16. Metheny NA. Risk factors for aspiration. JPEN J Parenter Enter Nutr. 2002;26(6 suppl):S26-S33. [CrossRef]
17. Lee SP, Lee KN, Lee OY, et al. Risk factors for complications of percutaneous endoscopic gastrostomy. Dig Dis Sci. 2014;59(1):117-125. [CrossRef]
18. Arnold M, Liesirova K, Broeg-Morvay A, et al. Dysphagia in acute stroke: incidence, burden, and impact on clinical outcome. PLoS One. 2016;11(2):e0148424. [CrossRef]
19. Pih GY, Na HK, Ahn JY, et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion. BMC Gastroenterol. 2018;18(1):101. [CrossRef]
20. Yang CW, Lin HH, Hsieh TY, Chang WK. Palliative enteral feeding for patients with malignant esophageal obstruction: a retrospective study. BMC Palliat Care. 2015;14:58. [CrossRef]