Early versus delayed feeding after placement of percutaneous endoscopic gastrostomy tube with safe anesthetic techniques

Abstract

Objective To compare the safety of early (≤4 h) versus 24 h tube feeding after percutaneous endoscopic gastrostomy (PEG) tube placement and to determine the effectiveness of i.v. sedation combined with ultrasound-guided, left side transversus abdominis plane (TAP) block versus combination with local anesthetic (LA) infiltration for PEG placement. Background Tube feeding used to be delayed up to 24 h after PEG placement, but results from many randomized controlled trials revealed that there was no need for delaying the tube feeding. The procedure was earlier done with general anesthesia or i.v. sedation with LA infiltration, but the use of i.v. sedation with TAP block may be another option. Patients and methods This was a prospective randomized study including 60 patients, requiring long-term nutritional support, who underwent the PEG procedure at GIT Endoscopy Unit, Damanhour Teaching Hospital, El Beheira, Egypt; between August 2017 and March 2018. Patients were randomly allocated into two equal groups, in group A; early tube feeding (≤4 h) was done and performed with i.v. midazolam and propofol-based sedation combined with ultrasound-guided, left side TAP block, whereas in group B; delayed tube feeding (24 h postprocedure) was done and performed with i.v. midazolam and propofol-based sedation with LA infiltration. Results There were no statistically significant differences between both groups with respect to procedure-related or anesthesia-related complications. Conclusion Early tube feeding (≤4 h) after PEG placement may be a safe option to delayed (24 h postprocedure) feeding. I.v. sedation combined with ultrasound-guided, left side TAP blockade can be used successfully as the primary anesthetic modality for PEG placement.