4733 Outcome of long term home enteral nutrition in patients with malignant dysphagia.

Abstract

Background:Patients with a variety of malignancies may have severe dysphagia due to direct involvement of the gastrointestinal tract, the central nervous system, or as a result of antitumor therapies. In this setting enteral nutrition may be lifesaving and may be required for prolonged periods of time. Currently, neoplastic diseases account for approximately one-half of all patients receiving home enteral nutrition. Methods: A review of the records of all patients with malignant dysphagia who received home enteral nutrition for greater than 1 year was undertaken. For each patient the following factors were identified: age, primary cancer, type of enteral access, calories received, duration of therapy, complications, and need for tube replacement. Results: 82 patients were studied. Their mean age was 61 years (range 18-84). Primary cancers were as follows: head and neck 59 (71.9%), gastroesophageal 14 (17.0%), central nervous system 3 (3.6%), ovarian 2 (2.4%), and others 4 (4.9%). Enteral access devices used for long term feeding included percutaneous endoscopic gastrostomy tube (PEG) in 30 (36.6%) patients, low profile endoscopic button gastrostomy tube (PEGbutton) in 29 (35.3%) patients, percutaneous endoscopic jejunostomy tube (PEJ) in 9 (10.9%) patients, low profile endoscopic button jejunostomy tube (PEJ-button) in 6 (7.3%) patients, surgical jejunostomy tubes in 8 (8.7%) patients. On average, patients received 1978 cal/day (range: 500-3000) and were maintained on home enteral nutrition for 976 days (range: 367-3026). Complications at the tube site were: infection in 4 patients (4.8%), significant leakage in 2 patients (2.4%), and bleeding in 1 patient (1.2%). Metabolic and gastrointestinal complications were: 15 patients (18.2%) with diarrhea which required change of formula, 10 patients (12.2%) with constipation, 10 patients (12.2%) with hyperglycemia, and 1 patient (1.2%) with hyponatremia. Average lifespan of the enteral access devices was: PEG = 690 days, PEG button = 1701 days, PEJ = 591 days, PEJ button = 902 days, and surgical jejunostomy = 1114 days. Conclusions:Home enteral nutrition is a safe and effective means of long term nutritional support in patients with severe malignant dysphagia.