A clinical research about the outcome of percutaneous endoscopic gastrostomy cases～Focusing on the final stage of life～

Abstract

For elderly people undergoing tube feeding, it may be necessary to discontinue tube feeding due to a decline in physical function. We conducted retrospective clinical research of the outcomes of the patients who underwent tube feeding through gastrostomy. The number of patients who underwent endoscopic gastrostomy for 5 years from 2017 to 2021 was 50 cases (male; 18, female; 32), and then 20 cases survived and 30 cases were dead at the end of May 2022. 20 patients of the deceased cases received tube feeding for more than 3 months and could be tracked the progress. In addition, among patients who underwent PEG at another hospital and were subsequently followed up at our hospital, we found 14 cases in which tube feeding was discontinued or the patient died during the same period, and the progress could be followed. We investigated and tabulated the clinical course of these 34 cases. Tube feeding was discontinued in 26 cases (76.5%) during the course of hospitalization. The main reason was a decrease in SpO2, followed by fever, an increase in sputum, vomiting, and diarrhea. The average time from cessation of feeding to death was 25.8 days (min.; 1 day, max.; 138 days); meanwhile, PPN or subcutaneous infusion was performed. In addition, O-PNI during the period of tube feeding discontinuation was observed significant decrease compared to during the course of treatment. The cause of death was diagnosed as aspiration pneumonia in 23 cases (67.6%), senility in 4 cases (11.8%), heart failure in 3 cases (8.8%), pneumonia in 2 cases (5.9%), acute respiratory failure in 1 case (2.9%), and others in 1 case. If a patient receiving tube feeding shows signs of decline in physical function, including a decrease of O-PNI, it may be necessary to consider measures for the final stage of life, such as reducing or discontinuing tube feeding.