S1251 Extending Value or Extending Care: Outcomes of Percutaneous Endoscopic Gastrojejunostomy Tubes at a Tertiary Care Center

Introduction: Post-pyloric feeding is a viable route of enteral nutrition for patients who are critically ill or have other contraindications to gastric feeding. It is important to consider the known risks associated with percutaneous endoscopic gastrojejunostomy tubes (PEG-J) placement to individualize care to each patient. We performed a retrospective chart review to assess the indications, durability, and effect on patient hospitalization of PEG-J placement at a tertiary care center. Methods: We reviewed all PEG-J placements performed by gastroenterology services at the University of Kentucky from 2020 to 2023. A chart review was conducted on a total of 310 charts and of those 113 were excluded due to incomplete chart or PEG-J not being placed. In the remaining charts, we identified key characteristics such as indication for placement, PEG-J's requiring revision, time to revision, number of revisions, length of stay, previous abdominal surgery, and the presence of malignancy. Post-procedure complications were also identified during the review. Results: Our study consisted of 104 men and 93 females with an average age of 59.2 years. At the time of PEG-J placement, 76.1% of patients had a previous abdominal surgery and 70.1% had concurrent or recent malignancy. The most common indication for PEG-J placement was failure to thrive at 42.6%, followed by gastric outlet obstruction at 17.3%. The percentage of patients requiring revision was 44.7% with average of 66.4 days to revision and 1.84 revisions per PEG-J. Post-procedure complications occurred at the following frequencies: clogging (25.9%), retraction of jejunal limb (21.8%), aspiration (6.60%), and bleeding (3.55%). Of note, the average number of all-cause readmissions per patient was 2.64. Conclusion: Although technical success in the placement of a PEG-J is high, our retrospective study highlights the relatively short durability of the PEG-J and frequent need for revision. Revision often means a second sedation and therefore increased inherent risk to the patient. Our study finds similar duration to revision as the American Society for Gastrointestinal Endoscopy Guidelines (66 days vs 55 days) and slightly decreased percent of retraction of the jejunal-limb (22% vs 33%). Therefore, when considering placement of a PEG-J, one must take into account the desired duration of therapy, indication for placement, and overall morbidity in the setting of possible multiple sedations.