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Magaraufun um húð með hjálp speglunar á Íslandi 2000-2009. Ábendingar, fylgikvillar og siðfræðileg álitamál

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Authors
Sigurbjörn Birgisson
Issue Date
2012-02

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Other Titles
Percutaneous endoscopic gastrostomy in Iceland over 10 year period: a retrospective study of indications, complications and ethical issues
Citation
Læknablaðið 2012, 98(2):97-102
Abstract
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.
Tilgangur: Magaraufun um húð með hjálp speglunar (percutaneous endoscopic gastrostomy - PEG) er kjöraðferð til gervinæringar og vökvunar sjúklinga um görn til lengri tíma. Tilgangur rannsóknarinnar var að kanna tíðni, ábendingar, árangur og siðferðileg álitamál PEG-aðgerða á Íslandi á 10 ára tímabili. Efniviður og aðferðir: Afturskyggn rannsókn var gerð á fullorðnum sjúklingum sem fengu PEG á Íslandi á árunum 2000-2009. Sjúklingar voru fundnir með tölvuleit á PEG-aðgerðarkóðum og speglunarsvörum og sjúkraskrár skoðaðar til að finna ábendingar og fylgikvilla PEG-aðgerða, dánartíðni og siðferðileg álitamál sem tengjast PEG-aðgerðum. Niðurstöður: 278 sjúklingar fóru í PEG-aðgerð á tímabilinu. Árleg tíðni þeirra var 12,8/100,000 að meðaltali. Miðaldur var 70 ár og hlutfall karla 59%. Klínískar upplýsingar fengust hjá 263 sjúklingum (95%). Algengustu ábendingar aðgerðanna voru taugasjúkdómar (61%) og krabbamein (13%). Heilabilun var ábending í aðeins 0,8% tilfella. Fylgikvillar urðu hjá 17 sjúklingum (6,5%), þar af voru 1,9% meiriháttar og 4,6% minniháttar. Lífhimnubólga var algengasti fylgikvillinn (2,7%) og húðsýking hjá 1,9%. Aðgerðartengd dánartíðni var 0,8% og 30 daga dánartíðni var 13%. Sjö (2,7%) tilfelli voru metin sem siðferðileg álitamál. Ályktun: Þetta er fyrsta rannsókn sem birt hefur verið um PEG-aðgerðir hjá heilli þjóð. Í samanburði við aðrar rannsóknir er tíðni fylgikvilla og dánartíðni vegna aðgerðanna hér á landi með því lægsta sem gerist. PEG-aðgerðir hérlendis eru flestallar gerðar í samræmi við viðurkenndar ábendingar. Siðferðileg álitamál eru fátíð og tíðni PEG-aðgerða til næringar sjúklinga með heilabilun er sú lægsta sem þekkist.
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