Lukejohn W. Day, MD, from the Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, in San Francisco, California, USA describes his Original Article “Practice variation in PEG tube placement: trends and predictors among providers in the United States.”
Enteral access placement is performed by a variety of providers and specialties and remains a controversial issue in medicine. Our primary study aim was to examine trends in the incidence of enteral access procedures (specifically percutaneous endoscopic gastrostomy [PEG]) performed by gastroenterologists in the United States over the past 11 years (2000-2010). Our secondary aim was to assess provider, endoscopy setting, and patient related factors associated with PEG tube placement in the U.S.
Enteral access procedures (typically in the form of PEG) allow the short and long term option of providing nutrients and medications into the gastrointestinal (GI) tract for patients who cannot maintain adequate oral intake. PEG tube placement is performed most frequently by gastroenterologists but can also be performed by other providers. However, there is a lack of current data on enteral access placement, and in particular PEG tube placement, in the U.S. with significant gaps in the literature. Given that the U.S. population is living longer, with more chronic medical problems that may necessitate the need for PEG tube placement, more current data on the incidence and associated predictors of this procedure are clearly needed.
In a large cohort of providers across the U.S. who participated in the Clinical Outcomes Research Initiative (CORI), we determined the incidence of PEG tube placement from 2000-2010 was 1.7%. The majority of PEG tube placements in the U.S. were performed by gastroenterologists in our study. At the same time, there was a significant decrease in the incidence of PEG tube placement among gastroenterologists between 2000-2010 in stable CORI endoscopy sites. In the U.S., significant practice variation was noted in PEG tube placement with respect to patient and provider characteristics as well as endoscopy settings. Our results highlight the need for more research in this area in order to improve the quality, cost, and use of resources dedicated to PEG tube placement. Furthermore, now that the demographics of patients receiving PEG tubes have been characterized, further research is needed to determine if PEG tubes benefit in terms of nutrition, survival and quality of life.
Read the abstract of this article here.
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