Changes in the Indications for and Outcomes of Gastrostomy Tube Placement: an Analysis of Serial, Prospective Multi-Site Audits in Northern England

OBJECTIVE:Gastrostomy tubes placed either endoscopically (percutaneous endoscopic gastrostomy (PEG)) or radiologically (radiologically inserted gastrostomy (RIG)) are established as standard methods for medium to long-term enteral feeding. There is a paucity of large-scale audit data to identify the main indications, complication rates and outcomes of patients having a PEG or RIG in the UK. The aim of our study was to determine changes in the use of and outcomes from gastrostomy tube placement in a large cohort of patients across the North East of England and North Cumbria. METHODS:The Northern Nutrition Network is a multidisciplinary network involving all hospitals in the North East of England and North Cumbria-an area with a population of 3.2 million in 2024. We conducted six 3-month cross-sectional prospective audits covering all hospitals where gastrostomies are placed between 2004 and 2022. RESULTS:A total of 889 procedures were performed during the six audit periods. Mean age has decreased from 71 years in 2004 to 63 years in 2022. Estimated incidence of gastrostomy placement in 2022 was 19.2 per 100 000. The most common indication in the first three audits was stroke; however, subsequently, this was replaced by dysphagia due to an ear-nose-throat/upper gastrointestinal malignancy. The use of prophylactic antibiotics increased from 83% to 93% during the 18-year period. 7-day mortality reduced from 2% in 2004 to 1% in 2022. Reduction was demonstrated in 30-day mortality rate from 9% in 2004 to 2.5% in 2022. CONCLUSION:Changes in gastrostomy placement practice have occurred over time, with a change in the most common indication, a trend to use in younger patients, greater use of prophylactic antibiotics and a reduction in 7-day and 30-day mortality. Dementia no longer appears as an indication for the placement of a gastrostomy, in keeping with international guidelines.