Brief Article
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World J Gastroenterol. Oct 28, 2010; 16(40): 5084-5091
Published online Oct 28, 2010. doi: 10.3748/wjg.v16.i40.5084
Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan
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
Yutaka Suzuki, Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara-shi, Tochigi 329-2763, Japan
Seryna Tamez, Department of Molecular Epidemiology, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
Akihiko Murakami, Endoscopy Unit, Iwate prefectural Central Hospital, 1-4-1 Ueda, Morioka-shi, Iwate 020-0066, Japan
Akihiko Taira, Department of Internal Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama-shi, Okayama 708-0841, Japan
Akihiro Mizuhara, Department of Surgery, Higashi Washinomiya Hospital, 3-9-3 Sakurada, kuki-shi, Saitama 340-0203, Japan
Akira Horiuchi, Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane-shi, Nagano 399-4117, Japan
Chie Mihara, Department of Neurology, Ebina Medical Support Center, 1519 Kawaguchi, Ebina-shi, Kanagawa 243-0433, Japan
Eiji Ako, Department of Surgery, Sumitomo Hospital, 5-3-20 Nakanoshima, Kita-ku, Osaka-shi, Osaka 530-0005, Japan
Hirohito Muramatsu, Department of Gastroenterology, Kiyota Hospital, 1-1-1-1 Shin-ei, Kiyota-ku, Sapporo-shi, Hokkaido 004-0831, Japan
Hitoshi Okano, Department of Gastroenterology, Okano Clinic, 3 Higashida-cho Jodoji, Sakyo-ku, Kyoto-shi, Kyoto 606-8411, Japan
Hitoshi Suenaga, Department of Geriatrics, Hitachikoh Hospital, 3-4-22 Kujicho, Hitachi-shi, Ibaraki 319-1222, Japan
Kazuaki Jomoto, Department of Internal Medicine, Jomoto Gastroenteric and Internal Medical Clinic, 5-8-9 Kuhonji, Kumamoto-shi, Kumamoto 862-0976, Japan
Junya Kobayashi, Department of Surgery, Fujiyoshida Municipal Hospital, 6530 Kamiyoshida, Fujiyoshida-shi, Yamanashi 403-0005, Japan
Katsunari Takifuji, 2nd Department of Surgery, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
Kazuhiro Akiyama, Department of Surgery, Tokatsu-clinic Hospital, 865-2 Hinokuchi, Matsudo-shi, Chiba 271-0067, Japan
Koh Tahara, Department of Surgery, Kure Kyosai Hospital, 2-3-28 Nishi-chuo, Kure-shi, Hiroshima 737-8505, Japan
Koji Onishi, Department of Internal Medicine, Matsue Seikyo Genaral Hospital, 8-8-8 Nishitsuda, Matsue-shi, Shimane 690-8522, Japan
Makoto Shimazaki, Department of Gastroenterology, Hirano General Hospital, 176-5 Kurono, Gifu-shi, Gifu 501-1192, Japan
Masami Matsumoto, Department of Internal Medicin, Nara Prefectural Gojo Hospital, 5-2-59 Noharanishi, Gojo-shi, Nara 637-8511, Japan
Masashi Ijima, Department of Internal Medicine, Isesaki Municipal Hospital, 12-1 Tsunatorihonmachi, Isesaki-shi, Gunma 372-0812, Japan
Masato Murakami, Department of Internal Medicine, Murakami Memorial Hospital, 739 Omachi, Saijo-shi, Ehime 793-0030, Japan
Masato Nakahori, Digestive Endoscopy Center, Sendai Kousei Hospital, 4-15 Hirose-machi, Aoba-ku, Sendai-shi, Miyagi 980-0873, Japan
Michiaki Kudo, Department of Surgery, Onishi Hospital, 139-1 Onishi, Fujioka-shi, Gunma 370-1401, Japan
Michio Maruyama, Department of Surgery, Tokyo Metropolitan Ohkubo Hospital, 2-44-1 Kabuki-cho, Shinjuku-ku, Tokyo 160-8488, Japan
Mikako Takahashi, Department of Internal Medicine, Tsuruoka Kyoritsu Hospital, 9-34 Humizono-cho, Tsuruoka-shi, Yamagata 997-0816, Japan
Naohiro Washizawa, Nutritional Therapy Center, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Shigeru Onozawa, Home Care Department, Kameda Medical Hospital, 916-9 Higashi-cho, Kamogawa-shi, Chiba 296-8602, Japan
Satoshi Goshi, Endoscopic Treatment Center, Japan Labour Health and Welfare Organization Niigata Rousai Hospital, 1-7-12 Touun-cho, Joetsu-shi, Niigata 942-8502, Japan
Satoyoshi Yamashita, Department of Gastroenterology and Hepatology, Social Insurance Shimonoseki Welfare Hospital, 3-3-8 Kami-shinchi-cho, Shimonoseki-shi, Yamaguchi 750-0061, Japan
Shigeki Ono, Department of Gastroenterology, Ako City Hospital, 1090 Nakahiro, Ako-shi, Hyogo 678-0232, Japan
Shin Imazato, Percutaneous Endoscopic Gastrostomy Center, Oita Kensei Hospital, 1-1-15 Kogazuru, Oita-shi, Oita 870-0935, Japan
Shinji Nishiwaki, Department of Internal Medicine, Nishimino Kosei Hospital, 986 Oshikoshi, Yoro-cho, Yoro-gun, Gifu 503-1394, Japan
Shuichirou Kitahara, Department of Pediatric Surgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano-shi, Nagano 380-8582, Japan
Takao Endo, Department of Internal Medicine, Sapporo Shirakaba-dai hospital, 2-18-7-26 Tukisamu Higashi, Toyohira-ku, Sapporo-shi, Hokkaido 062-0052, Japan
Takao Iiri, Department of Gastroenterology, Tachikawa General Hospital, 3-2-11 Kamedamachi, Nagaoka-shi, Niigata 940-8621, Japan
Takeshi Nagahama, Department of Surgery, Tokyo Metropolitan Health Medical Treatment Corporation Toshima Hospital, 33-1 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
Takuto Hikichi, Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
Tatsuya Mikami, Department of Internal Medicine, Hirosaki Municipal Hospital, 3-8-1 Ohmachi, Hirosaki-shi, Aomori 036-8004, Japan
Tetsuo Yamamoto, Department of Gastroenterology, National Hospital Organization Yonago Medical Center, 4-17-1 Kuzumo, Yonago-shi, Tottori 683-8518, Japan
Tetsushi Ogawa, Department of Surgery, Maebashi red cross hospital, 3-21-36 Asahi-cho, Maebashi-shi, Gunma 371-0014, Japan
Tomoko Ogawa, Department of Neurology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara-shi, Tochigi 329-2763, Japan
Tomoyuki Ohta, Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, 33-14-3-1 kita, Higashi-ku, Sapporo-shi, Hokkaido 065-0033, Japan
Toshifumi Matsumoto, Department of Surgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu-shi, Oita 874-0011, Japan
Toshiroh Kura, Department of Gastroenterology, Naganuma Municipal Hospital, 2-2-1 Chuo-minami, Naganuma-cho, Yubari-gun, Hokkaido 069-1332, Japan
Tsutomu Kikuchi, Department of Surgery, Kanazawa Nishi Hospital, 6-15-41 Ekinishihonmachi, Kanazawa-shi, Ishikawa-shi 920-0025, Japan
Tsuyoshi Iwase, Department of Internal Medicine, Kyoto Kujo Hospital, 10 Karahashi Rajomon-cho, Minami-ku, Kyoto-shi, Kyoto 601-8453, Japan
Tsuyotoshi Tsuji, Department of Gastroenterology, Akita City Hospital, 4-30 Kawamotomatsuoka-cho, Akita-shi, Akita 010-0933, Japan
Yukio Nishiguchi, Department of Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-Hondori, Miyakojima-ku, Osaka-shi, Osaka 534-0021, Japan
Mitsuyoshi Urashima, Department of Molecular Epidemiology, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
Author contributions: Suzuki Y organized the study design as a principal investigator, Urashima M analyzed the data, Urashima M and Tamez S wrote the paper; all the other authors contributed to data collection.
Correspondence to: Mitsuyoshi Urashima, MD, PhD, MPH, Department of Molecular Epidemiology, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan. urashima@jikei.ac.jp
Telephone: +81-3-34331111 Fax: +81-3-54001250
Received: May 6, 2010
Revised: June 10, 2010
Accepted: June 17, 2010
Published online: October 28, 2010
Abstract

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.

Keywords: Percutaneous endoscopic gastrostomy; Enteral nutrition; Comorbidity; Survival; Risk factor