Objective:  Percutaneous endoscopic gastrostomy (PEG) is the preferred  method for long term enteral feeding. No nationwide study has reported on the experience and outcome of PEG procedure. The aim of this study was to describe the frequency, indications, complications, mortality and ethical issues related to PEG procedures in Iceland.

Material and methods:  A retrospective study was performed on all adult patients who had PEG procedures in Iceland between 2000-2009. Medical charts from patients found were reviewed and data regarding demographics, indications, complications, mortality and ethically controversial cases was obtained.

Results:  A total of 278 patients had PEG procedures during the 10 year study period. There were 163 men and 115 women with a median age of 70 years. The mean annual incidence of PEG procedures was 12.8/100.000. Sufficient medical data for evaluation was obtained from 263 patients. The most common indications were neurological disorders (61%) and malignancies (13%). Dementia accounted for only 0.8% of the indications. Total complication rate was 6.5%  with 1.9% being major and 4.6% minor complications. Peritonitis was the most common (2.7%) complication followed by peristomal skin infection (1.9%). Operative mortality was 0.8% and 30 day mortality rate was 13%.  In seven (2.7%) cases the PEG procedure was considered to be ethically and medically controversial.

Conclusion:  This is the first published nationwide study on the experience of PEG procedures. The complication and mortality rates in Iceland are among the lowest reported. The indications reported here are in agreement with national guidelines with the rate of PEG procedures in ethically controversial cases being very rare.

Sigurbjörn Birgisson
Internal medicine, University Hospital Landspítali.

Figure 1.  Number of percutaneous endoscopic gastrostomy procedures performed annually in Iceland from 2000-2009 (n=278).

Table I. Indications for percutaneous endoscopic gastrostomy in Iceland from 2000-2009 (n=263).

Table II.  Complications of percutaneous endoscopic gastrostomy in Iceland 2000-2009 (n=17).