ORIGINAL ARTICLE Prevalence and in-hospital mortality of gastrostomy and jejunostomy in Japan: a retrospective study with a national administrative database Akahito Sako, MD, MPH, 1 Hideo Yasunaga, MD, PhD, 2 Hiromasa Horiguchi, PhD, 3 Kiyohide Fushimi, MD, PhD, 4 Hidekatsu Yanai, MD, PhD, 1 Naomi Uemura, MD, PhD 5 Ichikawa, Chiba, Japan Background: PEG is widely used; however, large-scale data for PEG have been lacking. Objective: To estimate the prevalence of placement of gastrostomy and jejunostomy tubes and to elucidate the patient background characteristics and their associations with in-hospital mortality. Design: A retrospective analysis of the Japanese administrative claims database. Setting: Japanese acute-care hospitals. Patients: A total of 64,219 patients who underwent gastrostomy or jejunostomy tube insertion between July and December, 2007 to 2010, were identified among 11.6 million discharge records. Intervention: Placement of gastrostomy and jejunostomy tubes. Main Outcome Measurements: In-hospital mortality and the associated risk factors. Results: The mean age was 77.4 years; O90% of patients were aged O60 years. Cerebrovascular disease and pneumonia were the most frequently recorded diagnoses, followed by neuromuscular disease and dementia. The estimated annual number of gastrostomy and jejunostomy placements in Japan ranged from 96,000 to 119,000. The in-hospital mortality was 11.9%, and the significantly associated risk factors were male sex, older age, placement of a jejunostomy tube, urgent admission, hospital with lower bed capacity, the presence of malignancy, miscellaneous diseases, pneumonia, heart failure, renal failure, chronic liver diseases, pressure sores and sepsis, and occurrence of peritonitis and/or GI perforation, GI hemorrhage, and intra-abdominal hemorrhage. Limitations: Retrospective investigation of administrative database. Conclusion: Our large-scale data revealed the current status of gastrostomy tube placement in Japan. This can contribute to individual decision-making and the public consensus regarding artificial nutritional support in the elderly. (Gastrointest Endosc 2014;-:1-9.) Abbreviations: CCI, Charlson Comorbidity Index; DPC, Diagnosis Proce- dure Combination; ICD-10, International Classification of Diseases 10th Revision. DISCLOSURE: This work was supported by a grant-in-aid for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (H22-Policy-031), (H. Yasunaga) by a grant-in-aid for Scientific Research B from the Ministry of Education and Science (22390131), (H. Yasunaga) by the Funding Program for World-Leading Innovative R & D on Science and Technology, from the Council for Science and Technology Policy, Japan (0301002001001), (H. Yasunaga) and by a grant-in aid from the National Center for Global Health and Medicine (25-203) (N. Uemura). The funding agencies had no role in the conduct of the study, analysis and interpretation of data, or preparation of the article. All other disclosed no financial relationships relevant to this publication. Copyright ª 2014 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 http://dx.doi.org/10.1016/j.gie.2013.12.006 Received July 26, 2013. Accepted December 4, 2013. Current affiliations: Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan (1); Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (2); Department of Clinical Data Management and Research, Clinical Research Center, (footnotes continued on lastpage of article) www.giejournal.org Volume -, No. - : 2014 GASTROINTESTINAL ENDOSCOPY 1