Title: Prevalence and Significance of Incidental Endoscopic Findings in Patients with Neurological Abnormalities Undergoing Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement
Abstract: Purpose: Gastrointestinal (GI) bleeding is independently associated with severe dependence at discharge and mortality in patients with acute ischemic stroke. Incidence of GI bleeding ranges from 1.5-8% in hospitalized patients with acute ischemic stroke. There is limited information available on endoscopic abnormalities in the upper GI tract in patients with neurological abnormalities undergoing PEG tube placement. The purpose of this study was to estimate the prevalence of incidental endoscopic abnormalities and to evaluate its correlation with the risk of gastrointestinal bleeding. Methods: Endoscopic findings of patients with neurological conditions and undergoing PEG were retrospectively reviewed at University of Texas Health science center. The demographic features of patients admitted for neurological trauma and non traumatic neurological indications were compared using wilcoxon rank sum test. The prevalence of specific EGD findings were compared using Fisher's exact test. EGD findings such as ulcer or esophagitis which are strongly associated with gastrointestinal bleeding were considered abnormal while others were regarded as incidental findings. Results: EGD was performed in 275 patients who underwent PEG placement for stroke and in 60 patients with neurological-trauma (January 2009-December 2011). The median age of patients in with neuro-trauma and stroke were 59.5 years (range 16-93) and 67 (range 19-93) years, p=0.006 respectively. EGD revealed abnormal findings in 17 (28.33%) patients with neurotrauma and in 86 (31.27%) patients with stroke. Overall prevalence of ulcers was 25.37%, esophagitis was 12%, gastritis was 11%, polyps as 3.33%, atrophy was 0.6%, and strictures was 0.6%. EGD findings in the two groups are summarized in table below. Over a median follow-up of 23 days (1-1,005) days, GI bleed occurred in 9 (2.65%) patients, all of them had stroke. EGD abnormalities (ulcer or esophagitis) were present in 103 patients of whom 4 (3.88%) patients had bleeding as compared to 5 (2.16%) patients with none or incidental findings (p=0.465). Logistic regression revealed patients with EGD abnormalities were 79% more likely to have GI Bleed (Odd ratio: 1.79, 95% CI: 0.47-6.85, p=0.39). Conclusion: EGD abnormalities are common in patients admitted to neurological ICU. The risk of bleeding may be associated with presence of ulcer or esophagitis on EGD. These findings can serve as early warning signs to predict future GI bleeding.Table: No Caption available.
Publication Year: 2012
Publication Date: 2012-10-01
Language: en
Type: article
Indexed In: ['crossref']
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