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Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan

World Journal of Gastroenterology 2010年第40期16卷 5084-5091页

作者： Yutaka Suzuki Seryna Tamez Akihiko Murakami Akihiko Taira Akihiro Mizuhara Akira Horiuchi Chie Mihara Eiji Ako Hirohito Muramatsu Hitoshi Okano Hitoshi Suenaga Kazuaki Jomoto Junya Kobayashi Katsunari Takifuji Kazuhiro Akiyama Koh Tahara Koji Onishi Makoto Shimazaki Masami Matsumoto Masashi Ijima Masato Murakami Masato Nakahori Michiaki Kudo Michio Maruyama Mikako Takahashi Naohiro Washizawa Shigeru Onozawa Satoshi Goshi Satoyoshi Yamashita Shigeki Ono shin imazato shinji Nishiwaki Shuichirou Kitahara Takao Endo Takao Iiri Takeshi Nagahama Takuto Hikichi Tatsuya Mikami Tetsuo Yamamoto Tetsushi Ogawa Tomoko Ogawa Tomoyuki Ohta Toshifumi Matsumoto Toshiroh Kura Tsutomu Kikuchi Tsuyoshi Iwase Tsuyotoshi Tsuji Yukio Nishiguchi Mitsuyoshi Urashima Department of Surgery International Universi-ty of Health and Welfare Hospital Department of Molecular Epidemiology Jikei University School of Medicine Endoscopy Unit Iwate prefectural Central Hospital Department of Internal Medicine Tsuyama Chuo Hospital Department of Surgery Higashi Washi-nomiya Hospital Digestive Disease Center Showa Inan General Hospital Department of Neurology Ebina Medical Sup-port Center Department of Surgery Sumitomo Hospital Department of Gastroenterology Kiyota Hospital Department of Gastroenterology Okano Clinic Department of Geriatrics Hitachikoh Hospital Department of Internal Medicine Jomoto Gastroenteric and Internal Medical Clinic Department of Surgery Fujiyoshida Munici-pal Hospital 2nd Department of Surgery Wakayama Medical University Hospital Department of Surgery Tokatsu-clinic Hospital Department of Surgery Kure Kyosai Hospital Department of Internal Medicine Matsue Sei-kyo Genaral Hospital Department of Gastroenterology Hirano General Hospital Department of Internal Medicin Nara Prefectural Gojo Hospital Department of Internal Medicine Isesaki Mu-nicipal Hospital Department of Internal Medicine Muraka-mi Memorial Hospital Digestive Endoscopy Center Sendai Kousei Hospital Department of Surgery Onishi Hospital Department of Surgery Tokyo Metropoli-tan Ohkubo Hospital Department of Internal Medicine Tsuruoka Kyoritsu Hospital Nutritional Therapy Center Toho Uni-versity Omori Medical Center Home Care Department Kameda Medical Hospital Endoscopic Treatment Center Japan Labour Health and Welfare Organization Niigata Rousai Hospital Department of Gastroenterology and Hepatology Social Insurance Shimonoseki Welfare Hospital Department of Gastroenterology Ako City Hospital Percutaneous Endoscopic Gastrostomy Center Oita Kensei Hospital Department of Internal Medicine Nishimino Kosei Hospital Department of Pediatric Surgery Nagano Red Cross Hospital Department of Internal Medicine Sapporo Shirakaba-dai hospital Department of Gastroenterology Tachikawa

AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard models. RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors. CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors.

关键词： Percutaneous endoscopic gastrostomy Enteral nutrition Comorbidity Survival Risk factor

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