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Abstract
BackgroundThe appropriate time to initiate enteral nutrition after the placement of a percutaneous endoscopic gastrostomy (PEG) tube has been an area of limited research. There are no sufficient randomised prospective controlled trials in the paediatric population comparing the safety and tolerance of early feeding (3 h) after PEG placement. In order to reduce the period of fasting, inadequate nutritional support, and hospitalisation time, we decided to devise this study.Methods/DesignThis study is a multicentre, randomised, open-label trial designed to evaluate the tolerance and safety of early enteral nutrition after PEG placement in children. Patients are randomised to receive the first feeding bolus with a polymeric diet (1 kcal/ml) via a feeding tube 3 h after the PEG placement (group I - early enteral feeding) or 8 h after the procedure (group II - late enteral feeding). The key objective of the study is to compare the tolerance and safety of the early- and late-feeding modes after PEG placement in children. The primary endpoint is the number of patients who will achieve full feed (total fluid and caloric requirements) within 48 h of the first feeding bolus. The secondary endpoints are: the number of early and late complications, the duration of hospitalisation after PEG placement, gastric residuals (ml) total in the period up to 48 h since the first feeding bolus.DiscussionTo our knowledge this is the first study in paediatric patients to evaluate the tolerance and safety of early enteral nutrition after PEG placement. The goal is to establish an optimum standard procedure in the group of paediatric patients qualified for the PEG insertion procedure in Poland.Trial registrationClinicalTrials.gov ID NCT02777541, registration date 05/18/2016.
Highlights
The appropriate time to initiate enteral nutrition after the placement of a percutaneous endoscopic gastrostomy (PEG) tube has been an area of limited research
To our knowledge this is the first study in paediatric patients to evaluate the tolerance and safety of early enteral nutrition after PEG placement
PEG has become the preferred method for providing long-term enteral nutrition in children with insufficient oral intake
Summary
The appropriate time to initiate enteral nutrition after the placement of a percutaneous endoscopic gastrostomy (PEG) tube has been an area of limited research. Tube feedings have been delayed after PEG placement to the day and up to 24 h postprocedure. This decision is based on a standard convention, extrapolated from surgical guidelines, with little data to support the withholding of feedings after PEG placement. Despite the recent literature indicating early PEG feedings as a safe alternative, the common practice continues to be to significantly delay post-PEG feedings. It is essential, especially in children, to reduce to a minimum fasting time and begin to improve nutritional status as soon as possible. A short stay in hospital can be beneficial for both the medical centre and the child, and it could result in reducing the overall cost of the procedure
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