Assessment of the percutaneous endoscopic gastrostomy feeding tube as part of an integrated approach to enteral feeding.

Wicks, Claire; Gimson, A.; Vlavianos, Panagiotis; Lombard, Martin; Panos, Marios Z.; MacMathúna, Padraic; Tudor, M; Andrews, Kyle; Westaby, David

doi:10.1136/gut.33.5.613

“…Recently, some studies have reported poor outcome in some patients on HEN (Wicks et al, 1992). In our study no differences were detected among diagnosis groups, and a good survival was achieved in relation to the good mental status of patients with a high rate of patients with only oral supplementation.…”

Section: Discussionsupporting

confidence: 46%

Clinical and biochemical characteristics of patients with home enteral nutrition in an area of Spain

Luis

¹

,

Aller

²

,

Luis

³

et al. 2003

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Objective: The widespread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence, clinical and biochemical characteristics of a cohort of patients on home enteral nutrition (HEN). Design: Prospective observational study. Setting: Tertiary care. Subjects: Between January 1999 and December 2001, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. Interventions: Information for each patients was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported. Results: In 1999, the incidence of HEN in our area was patients 15 per 100 000 inhabitants. This incidence rate rose to 21.3 in 2000 and decreased to 9.52 in 2001. The mean age of all patients was 58.7 AE 13 y. The distribution of patients by diseases was: 71 (69.6%) had a head and neck cancer; 14 (13.7%) had a neurological disorder affecting swallowing (cerebrovacular accident and/or dementia); 6 (5.9%) had tumors in different locations with anorexia; and 11 (10.8%) had one of several miscellaneous diseases inducing dysphagia or anorexia. HEN was administered orally in 81 patients (79.4%), via a nasogastric tube (NGT) in 15 patients (14.7%), via a percutaneous gastrostomy (PEG) in five patients (4.9%), and via a jejunostomy in one patient (1%). The mean duration of HEN was 101 AE 46.9 days. During the course of HEN, six patients had diarrhea (5.9%), and four (3.9%) constipation, and two vomiting (2%) that did not require cessation of HEN. Albumin, prealbumin, transferrin and lymphocytes improved in all the groups, when comparing the first review with the last. After the follow-up (3 y) with review, each 3 months, 10 of the 102 patients (9.8%) had died, and 92 (90.2%) were alive. Survival probability was influenced by the access route, with the worse outcome in patients with no oral nutrition (NGT, PEG and jejunonostomy; hazard ratio: 24.9; 95% CI: 4.1 -52), adjusted by age, sex and diagnosis. Conclusions: In conclusion, HEN is a valid and safe technique for nutrition support, with a good clinical outcome in our area.

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“…Recently, some studies have reported poor outcome in some patients on HEN (Wicks et al, 1992), in our study no differences were detected among diagnosis groups, however a better improvement in biochemical and anthropometric parameters in group I (only oral supplements). Qualitative studies have been performed to detect improvement in everyday life (Lilley and Manthorpe, 2003).…”

Section: Discussioncontrasting

confidence: 39%

Experience of 6 years with home enteral nutrition in an area of Spain

Luis

¹

,

Aller

²

,

Izaola

³

et al. 2005

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Objective: The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence and characteristics of a cohort of patients on HEN during 6 years, after our previous pilot study of 3 years. Design: Prospective observational study. Setting: Tertiary care. Subjects: Between January 1999 and December 2004, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. Interventions: Information for each patient was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative, were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported.

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“…18 19 There is less interruption from tube displacement compared with nasogastric feeding. 20 There may also be less reflux and feed aspiration, suggesting that overnight feeding is relatively safer. 21 This is important for mobile patients who do not want to be constrained during the day.…”

Section: Percutaneous Endoscopic Gastrostomy (Peg)mentioning

confidence: 99%