The safety and efficacy of percutaneous endoscopic gastrostomy after recent myocardial infarction: a study of 28 patients and 40 controls at four university teaching hospitals

Abstract

Objectives: To analyze the risks versus benefits of percutaneous endoscopic gastrostomy (PEG) performed soon after myocardial infarction.

Methods: Retrospective review of 28 patients undergoing PEG within 30 days after myocardial infarction at four university teaching hospitals for study periods of up to 10 yr. Forty controls undergoing PEG were matched for age and sex and had no myocardial infarction during the prior 6 months.

Results: Indications for PEG were inability to eat because of stroke in 13, chronic dependency on mechanically assisted ventilation in seven, anoxic encephalopathy in five, dementia in two, and other in one. The mean patient age was 72.5 +/- 9.2 (SD) yr. PEG was performed on average 22.3 +/- 6.2 days after myocardial infarction. Seventeen patients were intubated and were receiving mechanically assisted ventilation at the time of PEG. PEG was successfully performed in all patients. Study patients suffered two insignificant complications, and one significant complication from PEG of bleeding at the gastrostomy site that required transfusion of 4 U of packed erythrocytes. Of note, no study patient suffered a cardiovascular complication due to PEG. The control complication rate was not significantly different (three insignificant and one significant complications, NS, Fisher's exact test). PEG feedings in study patients resulted in stabilization of body weight and significant improvement of the serum albumin level (from 2.2 +/- 0.3 gm/dl to 2.5 +/- 0.5 gm/dl, p < 0.03, Student's t test). Also the absolute lymphocyte count, hematocrit, and serum total protein level tended to improve after PEG. PEG contributed to transfer to a rehabilitation center, skilled nursing facility, or home in 19 study patients (70%; control rate = 78%, NS, chi 2).

Conclusion: Recent myocardial infarction is not an absolute contraindication to PEG. In this study, the benefits exceeded the risks of PEG in medically stable patients. PEG should be performed with monitoring by electrocardiography and pulse oximetry in medically stable patients. PEG is an elective procedure that should not be performed in highly unstable patients.