Mortality after percutaneous endoscopic gastrostomy in patients with cirrhosis: a case series.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tube placement can improve the nutritional status and the ability of a patient with cirrhosis to recover from surgery such as orthotopic liver transplantation. However, cirrhosis has been considered a significant contraindication to PEG tube placement.

OBJECTIVE: Our aim in this study was to describe the mortality and complications in a series of cirrhotic patients who underwent PEG at our institution.

DESIGN: Retrospective, single-institution case series.

PATIENTS: This study involved 26 consecutive patients with cirrhosis who underwent PEG between 1995 and 2005.

INTERVENTION: PEG tube placement.

MAIN OUTCOME MEASUREMENTS AND RESULTS: The 30-day mortality of the series of patients was 10 of 26 (38.5%), whereas the 90-day mortality was 11 of 26 (42.3%). Nine of the 10 patients who died in the first 30 days had ascites at the time of PEG tube placement. Two patients died as a direct consequence of complications from the PEG procedure, whereas the other deaths were related to progression of liver disease or factors not directly related to the PEG.

LIMITATIONS: The patients in this case series had varying levels of illness and reasons for PEG tube placement such that a generalization of outcomes may not be possible.

CONCLUSIONS: The overall mortality of patients with cirrhosis who underwent PEG is high. Although there is an increased risk, PEG tube placement in cirrhotic patients without ascites may be less risky. The benefits of PEG tube placement in patients with cirrhosis should be weighed heavily against the risks.