Brief Communication Percutaneous Endoscopic MARK
vs
Surgical Gastrostomy*
JONES, D.O., STEVEN A. SANTANELLO, D.O., From the Section
service. We reviewed our data in an effort to determine relative efficacy and cost effectiveness of the two techniques. Thirtyfive patients with PEGs were matched for age and diagnosis with 35 patients with GTs done by the same surgical service. PEGs were done in the endoscopy suite; GTs were done in the operating room: both under local anesthesia. Patients in PEG and GT groups were comparable in sex, diagnosis, and age. The PEG took less time to insert (15.3 vs 25.4 min, p < 0.001).
First proposed by Egeberg in 1837, gastrostomy has remained the conduit of choice for long-term enteral nutrition’. Previous reports from our institution suggested the surgical gastrostomy (GT) was not cost effective.’ Since then the percutaneous endoscopic gastrostomy (PEG) has become the chronic feeding conduit of choice on our surgical services. We reviewed our data in an effort to determine the comparative efficacy and cost effectiveness of the two procedures. METHODS
Using retrospective chart review, 35 patients having PEGs done from 1984 to 1987 were matched for age and diagnosis with 35 patients having GTs done from 1981 to 1984 by the same surgical service. Charts were reviewed for demographics, indications for surgery, operative time, morbidity, mortality, and hospital stay. Cost was estimated from a previous study.’ Follow up was complete to 90 days. PEGs were done in the endoscopy suite using a retrograde guide-wire technique;’ GTs were done in the operating room using a modified Stamm technique described previously:’ both under local anesthesia with intravenous sedation. The purpose of gastrostomy was to provide enteral nutrition in all patients, and was the sole procedure performed. Statistical analysis of continuous variables was with a two-tailed t-test for paired data; analysis for proportions was with chiwas
set at p
0.1), but postop stay for the PEG group tended to be shorter (17 us 24 days, p < 0.08). The PEG is faster and cheaper to insert than the GT, however major morbidity and mortality are the same. (Journal of Parenteral and Enteral Nutrition 14: 533-534, 1990) RESULTS
Patients in the PEG and GT groups were comparable sex and diagnosis, but the GT group was slightly younger, p < 0.01 (Table I). The GT took significantly longer to insert than PEG (25.4 ± 6.6 min us 15.3 ± 10.5 in
min,
p
0.1), but postoperative
GT stay for the PEG group was shorter and approached statistical significant (17 ± 20 days us 24 ± 21 days, p
0.1. There was no mortality directly related to either procedure. Minor morbidity, however, was much higher for the PEG group with nine complications us one for the GT group, p < 0.01 (Table II). Estimated insertion costs for the PEG group were about half the costs for the GT group, primarily because PEG placement didn’t require an operating room, an
533
Downloaded from pen.sagepub.com at Bibliothekssystem der Universitaet Giessen on May 25, 2015
534 TABLE I Patient
&dquo;&dquo;&dquo;&dquo;&dquo;’~&dquo;&dquo;&dquo;&dquo;’’’’’’’’’’’.I.~
*p
vs
Surgical Gastrostomy*
JONES, D.O., STEVEN A. SANTANELLO, D.O., From the Section
service. We reviewed our data in an effort to determine relative efficacy and cost effectiveness of the two techniques. Thirtyfive patients with PEGs were matched for age and diagnosis with 35 patients with GTs done by the same surgical service. PEGs were done in the endoscopy suite; GTs were done in the operating room: both under local anesthesia. Patients in PEG and GT groups were comparable in sex, diagnosis, and age. The PEG took less time to insert (15.3 vs 25.4 min, p < 0.001).
First proposed by Egeberg in 1837, gastrostomy has remained the conduit of choice for long-term enteral nutrition’. Previous reports from our institution suggested the surgical gastrostomy (GT) was not cost effective.’ Since then the percutaneous endoscopic gastrostomy (PEG) has become the chronic feeding conduit of choice on our surgical services. We reviewed our data in an effort to determine the comparative efficacy and cost effectiveness of the two procedures. METHODS
Using retrospective chart review, 35 patients having PEGs done from 1984 to 1987 were matched for age and diagnosis with 35 patients having GTs done from 1981 to 1984 by the same surgical service. Charts were reviewed for demographics, indications for surgery, operative time, morbidity, mortality, and hospital stay. Cost was estimated from a previous study.’ Follow up was complete to 90 days. PEGs were done in the endoscopy suite using a retrograde guide-wire technique;’ GTs were done in the operating room using a modified Stamm technique described previously:’ both under local anesthesia with intravenous sedation. The purpose of gastrostomy was to provide enteral nutrition in all patients, and was the sole procedure performed. Statistical analysis of continuous variables was with a two-tailed t-test for paired data; analysis for proportions was with chiwas
set at p
0.1), but postop stay for the PEG group tended to be shorter (17 us 24 days, p < 0.08). The PEG is faster and cheaper to insert than the GT, however major morbidity and mortality are the same. (Journal of Parenteral and Enteral Nutrition 14: 533-534, 1990) RESULTS
Patients in the PEG and GT groups were comparable sex and diagnosis, but the GT group was slightly younger, p < 0.01 (Table I). The GT took significantly longer to insert than PEG (25.4 ± 6.6 min us 15.3 ± 10.5 in
min,
p
0.1), but postoperative
GT stay for the PEG group was shorter and approached statistical significant (17 ± 20 days us 24 ± 21 days, p
0.1. There was no mortality directly related to either procedure. Minor morbidity, however, was much higher for the PEG group with nine complications us one for the GT group, p < 0.01 (Table II). Estimated insertion costs for the PEG group were about half the costs for the GT group, primarily because PEG placement didn’t require an operating room, an
533
Downloaded from pen.sagepub.com at Bibliothekssystem der Universitaet Giessen on May 25, 2015
534 TABLE I Patient
&dquo;&dquo;&dquo;&dquo;&dquo;’~&dquo;&dquo;&dquo;&dquo;’’’’’’’’’’’.I.~
*p
