Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy

Table 1 Potential factors and univariate analysis for each of the candidates

	Number of values	Significance probability	Odds ratio
Female sex	252	0.377	0.732
Age (yr)	245	0.377	1.007
Body mass index (weight2/height)	209	0.454	0.957
Performance status (ECOG scale)	252	0.996	0.999
Enteral nutrition before gastrectomy1	252	0.000	0.272
Alimentation by peripheral infusion before gastrectomy	252	0.983	1.014
Fever ≤ 48 h before gastrostomy (≥ 37.5°C)	243	0.188	1.874
Blood examination the day before gastrectomy
White blood cell count (/&mgr;L)	240	0.718	1.000
Hemoglobin (g/dL)1	240	0.010	0.754
Albumin (g/dL)1	240	0.092	0.483
C-reactive protein (mg/dL)	238	0.295	1.110
Fasting blood sugar (mg/dL)	240	0.150	1.006
Presence of esophageal hiatal hernia1	252	0.002	4.076
Presence of gastric ulcer or erosive gastritis	252	0.170	1.800
Past history of gastrectomy	252	0.315	2.428
Past history of CDED	252	0.258	1.774
Past history of paralytic ileus1	252	0.012	5.204
Past history of cholecystitis or cholangitis	252	0.367	1.489
Presence of arteriosclerotic disorder	252	0.835	0.898
Past history of aspiration pneumonia1	252	0.037	2.014
Presence of chronic renal dysfunction1	252	0.003	13.205
Past history of urinary tract infection	252	0.958	0.975
Presence of diabetes mellitus	252	0.611	0.805
Rehabilitation before gastrectomy	252	0.416	0.612
Use of clinical paths	252	0.843	1.078
Duration of procedure (min)	199	0.553	1.016

¹Items were used for the multivariate analysis.

Table 2 Patient background factors obtained on the day before PEG (mean ± SD)

	Patients with enteral nutrition problems after PEG	Patients without enteral nutrition problems after PEG
Number of patients	208	44
Sex (Male/female)	127/81	30/14
Age (yr)	75 ± 11 (range 38-99)	76 ± 9 (range 55-92)
Body mass index (weight2/height)	19.3 ± 3.1	18.8 ± 4.3
Performance status (EGOC scale)	3.6 ± 0.6	3.6 ± 0.5
Blood examination
White blood cell count (/&mgr;L)	6550 ± 2105	6421 ± 1954
Hemoglobin (g/dL)	11.9 ± 1.7	11.1 ± 1.6
Albumin (g/dL)	3.3 ± 0.4	3.1 ± 0.3
C-reactive protein (mg/dL)	1.12 ± 1.51	1.40 ± 1.66
Fasting blood sugar (mg/dL)	105 ± 36	114 ± 36

Table 3 Causes of enteral nutrition problems after PEG

	No.	%
Cases that required ≥ 1 mo after surgery to switch to complete enteral nutrition, or that required additional parenteral alimentation continuously
Pneumonia (aspiration pneumonia)	13 (8)	25
Paralytic ileus	8	15
Acute enterocolitis (CDED)	7 (5)	13
Biliary tract infection	5	10
Peritonitis	3	6
Urinary tract infection	3	6
Hemorrhagic gastric ulcer	1	2
Diarrhea	1	2
Drug-induced liver injury	1	2
Bacterial endocarditis	1	2
Aggravation of ASO	1	2
Stenosis of upper respiratory tract	1	2
Aggravation of chronic renal dysfunction	1	2
Cerebral infarction	1	2
Infection to central venous catheter	1	2
Sepsis	1	2
Convulsive seizure	1	2
Progression of hyponatremia	1	2
Fever (unknown origin)	1	2
Total	52	100
Patients that abandoned switching to enteral utrition using the gastrostoma and employed other nutritional methods
Pneumonia (aspiration pneumonia)	6 (6)	33
Paralytic ileus	2	11
Acute enterocolitis (CDED)	2 (1)	11
Biliary tract infection	2	11
Aggravation of chronic heart failure	2	11
Aggravation of chronic renal failure	2	11
Bleeding from fistula	1	6
Fever (unknown origin)	1	6
Total	18	100

ASO: Arteriosclerosis obliterans; CV: Central vein.

Table 4 Predictors identified by multivariate analysis

	Regression coefficients (B)	Standard error	Significance probability	Odds ratio
Enteral nutrition before gastrectomy	-1.369	0.397	0.000	0.248
Presence of esophageal hiatal hernia	1.728	0.512	0.001	5.629
Past history of paralytic ileus	1.634	0.773	0.035	5.123
Presence of chronic renal dysfunction	2.011	0.954	0.035	7.470

Table 5 Causes of enteral nutrition problems after PEG with their respective predictors

	No.	%
Parenteral alimentation before gastrectomy
Pneumonia (aspiration pneumonia)	14 (11)	33
Paralytic ileus	6	14
Acute enterocolitis (CDED)	5 (4)	12
Biliary tract infection	2	9
Aggravation of chronic renal dysfunction	2	5
Fever (unknown origin)	2	5
Peritonitis	1	2
Bleeding from fistula	1	2
Diarrhea	1	2
Drug-induced liver injury	1	2
Aggravation of chronic heart failure	1	2
Aggravation of ASO	1	2
Urinary tract infection	1	2
Sepsis	1	2
Infection to central venous catheter	1	2
Convulsive seizure	1	2
Total	43	100
Presence of esophageal hiatal hernia
Pneumonia (aspiration pneumonia)	8 (5)	44
Acute enterocolitis (CDED)	3 (2)	17
Paralytic ileus	2	11
Peritonitis	1	6
Aggravation of chronic heart failure	1	6
Stenosis of upper respiratory tract	1	6
Aggravation of chronic renal dysfunction	1	6
Cerebral infarction	1	6
Total	18	100
Past history of paralytic ileus
Paralytic ileus	3	38
Biliary tract infection	2	25
Pneumonia (aspiration pneumonia)	2 (2)	25
Peritonitis	1	13
Total	8	100
Presence of chronic renal dysfunction
Aggravation of chronic renal dysfunction	3	33
Aggravation of chronic heart failure	2	22
Pneumonia (Aspiration pneumonia)	2 (1)	22
Diarrhea	1	11
Fever (unknown origin)	1	11
Total	9	100