Longitudinal trends of percutaneous endoscopic gastrostomy in geriatric hospital units in Germany

PURPOSE: To quantify long-term trends in percutaneous endoscopic gastrostomy (PEG) use in geriatric inpatient care in Germany and describe associated diagnoses and in-hospital mortality. METHODS: We conducted a nationwide retrospective cohort study using the GEMIDAS Pro registry (2006-2024) and included all patients aged ≥ 60 years. According to the database items, we received information about the incidence of PEG placement, nutrition-relevant diagnoses, patients age, functional and mental status, length of hospital stay, where patients were admitted from and discharged to and the hospital mortality of patients with and without PEG placement. RESULTS: Among 1,355,436 admissions (≥ 60 y; mean age 83y; 67% women), 4091 (0.3%) underwent PEG placement. Annual prevalence declined from 1.31% (2006) to 0.07% (2024, p < 0.001), a 94.7% relative reduction (absolute decrease 1.24 percentage points). Binary logistic regression confirmed a 10% per-year reduction in the odds of PEG placement (OR 0.90, 95% CI 0.894-0.905; p < 0.001). Among PEG recipients, stroke was the most frequent nutrition-relevant main diagnosis and dysphagia the most frequent secondary diagnosis. Dementia was the main indication in only 0.8% of PEG recipients, and as a secondary diagnosis it declined from 40% (2006) to 15% (2024, p = 0.021). In-hospital mortality was higher with PEG than without (11% vs 3%, p < 0.001); mortality among PEG recipients decreased with an undulating course over time (24.3% in 2006 to 7.4% in 2024, p < 0.001). CONCLUSION: PEG use in German geriatric units declined substantially during the last two decades. The pattern aligns with a more selective, guideline-concordant practice focused on neurogenic dysphagia, alongside reduced use in dementia.