The principles of enhanced recovery after percutaneous endoscopic gastrostomy (ERaPEG): a UK tertiary center experience
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In brief
In brief
This UK study demonstrates that implementing an enhanced recovery pathway (ERaPEG) for pediatric PEG insertion significantly reduced hospital stay from 51.5 to 32 hours without increasing readmissions. The pathway proved safe and satisfactory to parents, with over 80% reporting confidence in post-operative gastrostomy management.
- Enhanced recovery pathway (ERaPEG) reduced median hospital stay from 51.5 to 32 hours after pediatric PEG insertion (p<0.001).
- 30-day readmission rates remained stable (6% vs 11%), demonstrating safety of earlier discharge with structured pathway.
- Over 80% of parents felt confident managing gastrostomy feeds post-discharge after standardized education and support.
- Most patients were neurodisabled children requiring PEG for medication/nutritional supplementation rather than exclusive feeding.
- ERAS principles applied to endoscopic procedures can improve resource utilization without compromising safety or family satisfaction.
Written by the GCMD Library team from the article.
Abstract
Purpose
Enhanced recovery after surgery (ERAS) pathways have been shown to improve surgical outcomes and patient satisfaction. The aim of the study was to assess whether the implementation of a perioperative enhanced recovery after percutaneous endoscopic gastrostomy (ERaPEG) pathway based on ERAS principles was safe, satisfactory to parents and improved outcomes.
Methods
Following a quality improvement project, a multimodal ERaPEG pathway was introduced as standard practice within the department and children undergoing elective same-day admission percutaneous endoscopic gastrostomy (PEG) at a single UK tertiary center were prospectively enrolled. Exclusion criteria were patients undergoing other concurrent procedures and those who underwent a laparoscopic assisted/open procedure. Data included patient demographics, underlying diagnosis, indication, length of stay (LOS) and 30-day readmission. Parental experience and satisfaction were determined using a questionnaire including 5-point Likert scales. A retrospective cohort was used for comparison. Data were analyzed using Chi-Square test and Mann–Whitney U tests.
Results
Ninety-five patients met the inclusion criteria: 50 pre and 45 post the implementation of ERaPEG. Median age was 3 and 2 years, respectively. Neurodisability was the underlying diagnosis in most patients (84%—pre-ERaPEG; 76%—post-ERaPEG). Most common PEG indication was medication/nutritional supplementation (52%—pre-ERaPEG; 51%—post-ERaPEG). The LOS significantly decreased from a median of 51.5 h (pre-ERaPEG) to 32 h (post-ERaPEG) (p < 0.001). Thirty-day readmission rates were similar (6% vs 11%). Most parents felt that the educational material was easy to access and understand. Post-operatively the majority of parents (≥ 80%) were confident in managing the gastrostomy device, setting up/giving the feeds and also felt that the LOS was appropriate.
Conclusion
This study shows that the implementation of an ERaPEG pathway significantly reduced LOS following PEG. In addition, the pathway was satisfactory to parents and offered the benefit of improved resource utilization.