Effect Of Percutaneous Endoscopic Gastrostomy Research Articles

Percutaneous gastrostomy, mechanical ventilation and survival in amyotrophic lateral sclerosis : an observational study in an incident cohort

Objective To analyze disease-modifying effects of percutaneous endoscopic gastrostomy (PEG) insertion for supporting nutrition, noninvasive ventilation (NIV), and tracheostomy-assisted ('invasive’) ventilation (TIV) in amyotrophic lateral sclerosis (ALS). Methods We retrospectively analyzed survival in a large population–based incident cohort that was prospectively followed up in our center. Analysis considered several known ALS-related prognostic variables. Results In this population, PEG and NIV in multivariable analysis significantly correlated to survival as computed by disease onset to death/tracheostomy. NIV was associated with better survival while PEG was associated with reduced survival. Other independent prognostic factors were age at ALS onset, diagnostic delay, and flail arm/leg and pure upper motor neuron (PUMN) phenotypes. The length of survival after TIV was significantly associated with age at ALS onset (inverse correlation) whereas other variables did not. The length of survival after TIV correlated to age at ALS onset in such a way that each additional year of age at ALS onset decreased survival by about 0.7 months. Patients who underwent both TIV and NIV did not experience a better survival than those who underwent TIV alone. Conclusion The lack of effect of enteral nutrition on ALS survival probably reflected the timing of PEG insertion in patients with more severe disease. By contrast, patients who used mechanical ventilation had an increased overall survival compared with non-ventilated ones. The study also provided new information showing that the combined use of NIV and TIV did not may prolong ALS survival as compared to TIV alone.

Effect of Percutaneous Endoscopic Gastrostomy on Quality of Life after Chemoradiation for Locally Advanced Nasopharyngeal Carcinoma: A Cross-Sectional Study.

(1) Background: Prophylactic percutaneous endoscopic gastrostomy (PEG) maintained nutritional status and improved survival of patients with locally advanced nasopharyngeal carcinoma (LA-NPC). However, the role of PEG in patients’ quality of life (QoL) is still controversial. We aimed to investigate the effect of PEG on the QoL of patients with LA-NPC without progression. (2) Methods: Patients with LA-NPC between 1 June 2010 and 30 June 2014 in Fujian Cancer Hospital were divided into PEG and non-PEG groups. The QoL Questionnaire core 30 (QLQ-C30), incidence of adverse effects, weight, and xerostomia recovery were compared between the two groups of patients without progression as of 30 June 2020. (3) Results: No statistically significant difference in the scores of each QLQ-C30 scale between the two groups (p > 0.05). The incidence of xerostomia was higher in the PEG group than in the non-PEG group (p = 0.044), but the association was not seen after adjusting for gender, age, T, and N stage (OR: 0.902, 95%CI: 0.485−1.680). No significant difference in the incidence of other adverse effects as well as in weight and dry mouth recovery (p > 0.05). (4) Conclusion: PEG seems not to have a detrimental effect on long-term Qol, including the self-reported swallowing function of NPC patients without progressive disease.

Effects of Percutaneous Endoscopic Gastrostomy in Patients With Huntington Disease.

To determine the impact of percutaneous endoscopic gastrostomy (PEG) tubes in patients with advanced Huntington disease (HD). A retrospective chart review of patients with HD was conducted to assess the rate of pneumonia and pressure ulcer, length of life, changes in weight, and serologic nutritional measures. Surviving and deceased patients with and without PEG tubes were compared using descriptive statistical analysis. One hundred forty-eight records were reviewed (39 patients with PEG tubes). The mean age of patients still alive and diagnosed with HD was 58.3 ± 12.7 years and age at death (n = 62) 57.7 ± 10.3 years. At the time of analysis, the mean duration of HD was 14.2 ± 7 years. Groups were similar in sex, age, and weight at admission. In those deceased, insertion of a PEG tube increased the length of life with HD by 3.6 years (16.2 ± 6.7 vs 13.2 ± 4.9 years). PEG tube placement significantly reduced cholesterol levels, increased the prevalence of skin ulcers and the rate of pneumonia. Insertion of a PEG tube did not significantly change weight or albumin levels. PEG tube placement in advanced HD provided benefit in the length of life, but weight, other nutritional measures, and the rate of pneumonia were either not impacted or worsened with the insertion of a PEG tube. Impact on quality of life needs further study, but providers, patients, and families should consider all options when discussing preferences for interventions. This study provides Class IV evidence that for patients with advanced HD, PEG tube placement increases the length of life but has no or negative impacts on nutritional measures.

Percutaneous Endoscopic Gastrostomy Reduces Aspiration Pneumonia Rate in Stroke Patients with Enteral Feeding in Convalescent Rehabilitation Wards.

ABSTRACTObjectives:The effect of percutaneous endoscopic gastrostomy (PEG) on the prevention of aspiration pneumonia and improvements in activities of daily living (ADL) for enteral feeding-dependent stroke patients is unclear. We sought to clarify differences in the rates of aspiration pneumonia and ADL improvement between stroke patients receiving PEG and those receiving nasogastric tube feeding (NGT) in convalescent rehabilitation wards.Methods:We assessed 10 years of data from the Kaga Regional Cooperation Clinical Pathway for Stroke, which covers patients in the southern district of Ishikawa Prefecture of Japan. Logistic regression analysis with propensity score adjustment was used to examine how the enteral feeding method affected aspiration pneumonia rates. Linear regression analysis, adjusted by propensity scores, was also performed to ascertain the effect of the enteral feeding method on ADL improvement.Results:Overall, 47 patients with PEG and 49 patients with NGT were analyzed. The incidence of aspiration pneumonia was 4.67 times higher in the NGT group than in the PEG group in the propensity score-adjusted logistic regression analysis (odds ratio 4.67, 95% confidence interval 1.30–16.67, P=0.02). The enteral feeding method had no significant effect on ADL improvement in the propensity score-adjusted linear regression analysis.Conclusions:In convalescent rehabilitation wards, aspiration pneumonia was more likely to occur in stroke patients with NGT than in those with PEG; however, the enteral feeding method did not affect ADL improvement. These results provide a basis for determining the appropriate enteral feeding method for stroke patients who cannot take adequate nutrition orally during convalescence/rehabilitation.

Percutaneous Endoscopic Gastrostomy Tubes May Be Associated With Preservation of Lung Function in Patients With Cystic Fibrosis.

Improving nutrition status of patients with cystic fibrosis (CF) has a positive effect on pulmonary function. We conducted a retrospective case-control study evaluatingthe effect of percutaneous endoscopic gastrostomy (PEG) placement on body mass index (BMI) and forced expiratory volume in 1 second percent predicted (FEV1 ) between matched subjects with CF who received PEG (n = 20) and controls who did not (n = 40). We observed that after adjusting for mutation class and baseline BMI, BMI percentile increased per month for those with PEG (0.51, 95% confidence interval (CI) = -0.05-1.08, P = .08), but decreased for those without PEG (-0.03, 95% CI = -0.33-0.28, P = .86); however, the difference (0.54; 95% CI = -0.10-1.18, P = .10) was not statistically significant. FEV1 change with time showed a decrease for patients with PEG (-0.04; 95% CI = -0.30-0.22, P = .74) and those without PEG (-.22; 95% CI = -0.45-0.01, P = .06). Although the decrease for those without PEG was higher than those with PEG, the difference between the groups was not statistically significant (0.18; 95% CI = -0.17-0.52, P = .32) CONCLUSION: Lung function trajectory showed a trend towards preservation among patients with CF who receive PEG despite lack of significant difference in BMI. There may be a favorable effect of PEG on lung function independent of changes in BMI.

Therapeutic effects of percutaneous endoscopic gastrostomy on survival in patients with amyotrophic lateral sclerosis: A meta-analysis.

Percutaneous endoscopic gastrostomy (PEG) is a method widely used for patients with amyotrophic lateral sclerosis (ALS); nevertheless, its effect on survival remains unclear. The purpose of this meta-analysis study was to determine the effects of PEG on survival in ALS patients. Relevant studies were retrieved from PubMed, EmBase, and the Cochrane Library databases, from inception to June 2017. Studies comparing PEG with other procedures in ALS patients were included. Odds ratios (ORs) in a random-effects model were used to assess the survival at different follow-up periods. Briefly, ten studies involving a total of 996 ALS patients were included. Summary ORs indicated that PEG administration was not associated with 30-day (OR = 1.59; 95%CI 0.93–2.71; P = 0.092), 10-month (OR = 1.25; 95%CI 0.72–2.17; P = 0.436), and 30-month (OR = 1.28; 95% CI 0.77–2.11; P = 0.338) survival rates, while they showed a beneficial effect in 20-month survival rate (OR = 1.97; 95%CI 1.21–3.21; P = 0.007). The survival rate was significantly prominent in reports published before 2005, and in studies with a retrospective design, sample size <100, mean age <60.0 years, and percentage male ≥50.0%. To sum up, these findings suggested that ALS patients administered with PEG had an increased 20-month survival rates, while there was no significant effect in 30-day, 10-month, and 30-month survival rates.

The effect of percutaneous endoscopic gastrostomy on aspiration pneumonia of patients with dysphagia

Objective To explore the preventive effect of percutaneous endoscopic gastrostomy (PEG) on aspiration pneumonia in patients with dysphagia. Methods The clinical data of 43 patients undertaking PEG was retrospectively collected and the incidence of aspiration pneumonia, microbiological examination of sputum and antibiotics use before and after PEG in all the patients were compared. Results After PEG, the incidence of aspiration pneumonia decreased significantly from 90.7% to 53.5% according to clinical diagnosis, from 70.4% to 18.5% according to the chest imaging. The use of β-lactamase inhibitor compound decreased significantly, but the detection rate of pseudomonas aeruginosa increased significantly compared with that before PEG. Conclusion PEG can decrease the incidence of aspiration and antibiotics use, and may increase the chances of pseudomonas aeruginosa colonization in the lower respiratory tract. Key words: Gastrostomy; Aspiration pneumonia; Dysphagia

Effects of percutaneous endoscopic gastrostomy on survival of patients in a persistent vegetative state after stroke.

To assess the effect of percutaneous endoscopic gastrostomy on short- and long-term survival of patients in a persistent vegetative state after stroke and determine the relevant prognostic factors. Stroke may lead to a persistent vegetative state, and the effect of percutaneous endoscopic gastrostomy on survival of stroke patients in a persistent vegetative state remains unclear. Prospective study. A total of 97 stroke patients in a persistent vegetative state hospitalised from January 2009 to December 2011 at the Second Hospital, University of South China, were assessed in this study. Percutaneous endoscopic gastrostomy was performed in 55 patients, and mean follow-up time was 18months. Survival rate and risk factors were analysed. Median survival in the 55 percutaneous endoscopic gastrostomy-treated patients was 17·6months, higher compared with 8·2months obtained for the remaining 42 patients without percutaneous endoscopic gastrostomy treatment. Univariate analyses revealed that age, hospitalisation time, percutaneous endoscopic gastrostomy treatment status, family financial situation, family care, pulmonary infection and nutrition were significantly associated with survival. Multivariate analysis indicated that older age, no gastrostomy, poor family care, pulmonary infection and poor nutritional status were independent risk factors affecting survival. Indeed, percutaneous endoscopic gastrostomy significantly improved the nutritional status and decreased pulmonary infection rate in patients with persistent vegetative state after stroke. Interestingly, median survival time was 20·3months in patients with no or one independent risk factors of poor prognosis (n=38), longer compared with 8·7months found for patients with two or more independent risk factors (n=59). Percutaneous endoscopic gastrostomy significantly improves long-term survival of stroke patients in a persistent vegetative state and is associated with improved nutritional status and decreased pulmonary infection. Percutaneous endoscopic gastrostomy is a promising option for the management of stroke patients in a persistent vegetative state.

Efficiency analysis on percutaneous endoscopic gastrostomy for patients with persistent dysphagia after stroke

Objective To observe the effects of percutaneous endoscopic gastrostomy (PEG)on mortality and complications in patients with persistent dysphagia after stroke using a points-scoring system for selecting PEG indication. Methods A total of 75 patients were divided into low score group without PEG, high score group without PEG and low score group with PEG (n=25 each). The follow-up period was 18 months, and the differences in complications, mortalities and survival periods among groups were compared. Results The number of times of aspiration pneumonia was (1.36±1.44) in low score group, (1.96±2.28) in high score group, (0.36±0.64) in low score group with PEG, with statistically significant differences among three groups (H=7.148, P=0.028). No difference in the morbidity of aspiration pneumonia was found between low score group and high score group (P=0.189). The number of times of aspiration pneumonia was decreased in low score groups after PEG versus in low score group without PEG (P=0.030) and in high score group (P<0.01). The number of times of gastrointestinal hemorrhage was (0.48±0.77)in low score group, (0.64±0.91) in high score group, (0.12±0.33) in low score group with PEG, with statistically significant differences among three groups (H=5.532, P=0.063). No statistically significant difference in gastrointestinal hemorrhage was found between low score groups and low score group after PEG (P=0.430), as well as between low score group and low score group with PEG (P=0.079). The morbidity of gastrointestinal hemorrhage was lower in low score group than in high score group (P=0.012). The survival rate at the observation end was 88.0% (22/25), 52.0% (13/25) and 92.0% (23/25) in low score group, high score group and low score group with PEG, respectively, with statistically significant difference among the three groups (χ2=7.906, P=0.001). Kaplan-Meier survival curve showed that the survival period were longer in the low score group with or without PEG than in high score group (P<0.01) , but no statistically significant difference was found between low score groups with or without PEG (P=0.626). Conclusions The reasonable evaluation using a points-scoring system before PEG might predict the prognosis of such patients: the higher score would indicate higher mortality. PEG operation for low score group with better condition could decrease the aspiration pneumonia and decrease gastrointestinal hemorrhage significantly, but could not prolong general survival time and decrease general mortality. Key words: Stroke; Deglutition disorders; Gastrostomy

Estimating the palliative effect of percutaneous endoscopic gastrostomy in an observational registry using principal stratification and generalized propensity scores.

Clinical disease registries offer a rich collection of valuable patient information but also pose challenges that require special care and attention in statistical analyses. The goal of this paper is to propose a statistical framework that allows for estimating the effect of surgical insertion of a percutaneous endogastrostomy (PEG) tube for patients living with amyotrophic lateral sclerosis (ALS) using data from a clinical registry. Although all ALS patients are informed about PEG, only some patients agree to the procedure which, leads to the potential for selection bias. Assessing the effect of PEG is further complicated by the aggressively fatal disease, such that time to death competes directly with both the opportunity to receive PEG and clinical outcome measurements. Our proposed methodology handles the “censoring by death” phenomenon through principal stratification and selection bias for PEG treatment through generalized propensity scores. We develop a fully Bayesian modeling approach to estimate the survivor average causal effect (SACE) of PEG on BMI, a surrogate outcome measure of nutrition and quality of life. The use of propensity score methods within the principal stratification framework demonstrates a significant and positive effect of PEG treatment, particularly when time of treatment is included in the treatment definition.

Percutaneous endoscopic gastrostomy improves nutritional status and reduces complications in patients with enteral nutrition support

Objective To evaluate the effect of percutaneous endoscopic gastrostomy (PEG) on the nutritional status and complication rate in patients with enteral nutrition support. Methods Sixty five patients receiving PEG from January 2008 to December 2014 were enrolled in the study. The nutritional status was examined and the incidence of complications was documented before and after PEG. Results The serum albumin, body mass index (BMI) and arm muscle circumference were (29.2±3.2)g/L, (18.0±1.0)kg/m2, (21.1±1.9)cm and (32.9±3.0)g/L, (18.8±1.6)kg/m2, (23.0±3.0)cm before and 1 month after PEG, respectively (t=-6.798, -3.202 and -3.957, all P<0.05). Compared to those before PEG, the serum albumin, BMI and arm muscle circumference at 3 and 6 months after PEG were increased to (35.4±4.9)g/L, (19.7±1.4)kg/m2, (24.9±2.2)cm (t=-7.845, -7.202, -10.432, all P<0.05) and (37.9±3.7)g/L, (20.7±1.6)kg/m2, (26.9±3.7)cm (t=-14.046, -10.686, -9.827, all P<0.05), respectively. Compared to those with nasal feeding, the incidence of aspiration pneumonia was decreased from 62% (40/65) to 18% (10/57) and the incidence of reflux esophagitis was decreased from 51% (33/65) to 19% (11/57) 6 months after PEG, respectively (χ2=24.3 and 13.5, all P<0.01). Conclusion PEG can improve nutritional status and reduce the incidence of aspiration pneumonia and reflux esophagitis for patients with enteral nutrition support. Key words: Gastroscopes; Percutaneous endoscopic gastrostomy; Nutritional status

The Effects of Percutaneous Endoscopic Gastrostomy on Quality of Life in Patients With Dementia

BackgroundTo examine the effects of percutaneous endoscopic gastrostomy (PEG) on quality of life (QOL) in patients with dementia.MethodsWe retrospectively included 53 Japanese community and tertiary hospitals to investigate the relationship between the newly developed PEG and consecutive dementia patients with swallowing difficulty between Jan 1st 2006 and Dec 31st 2008. We set improvements in 1) the level of independent living, 2) pneumonia, 3) peroral intake as outcome measures of QOL and explored the factors associated with these improvements.ResultsTill October 31st 2010, 1,353 patients with Alzheimer’s dementia (33.1%), vascular dementia (61.7%), dementia with Lewy body disease (2.0%), Pick disease (0.6%) and others were followed-up for a median of 847 days (mean 805 ± 542 days). A total of 509 deaths were observed (mortality 59%) in full-followed patients. After multivariate adjustments, improvement in the level of independent living was observed in milder dementia, or those who can live independently with someone, compared with advanced dementia, characterized by those who need care by someone: Odds Ratio (OR), 3.90, 95% confidence interval (95%CI), 1.59 - 9.39, P = 0.003. Similarly, improvement of peroral intake was noticed in milder dementia: OR, 2.69, 95%CI, 1.17 - 6.17, P = 0.02. Such significant associations were not observed in improvement of pneumonia.ConclusionsThese results suggest that improvement of QOL after PEG insertion may be expected more in milder dementia than in advanced dementia.

Non-invasive ventilation and gastrostomy may not impact overall quality of life in patients with ALS

Non-invasive positive pressure ventilation (NIPPV) may improve health-related quality of life (HRQoL) in patients with ALS. The effect of percutaneous endoscopic gastrostomy (PEG) on HRQoL is not known. Instruments measuring QoL more broadly have not been used to assess effects of these interventions. This study was undertaken to do so via the ALS-Specific Quality of Life Instrument-revised (ALSSQOL-R). A retrospective review was carried out of ALS patients who had undergone one QoL assessment prior to NIPPV or PEG initiation and two assessments following one of these interventions. Random coefficients models were developed. Twenty-two patients met criteria for inclusion: six NIPPV, 11 PEG, and five NIPPV + PEG. The ALSSQoL-R did not change significantly following NIPPV or PEG or both. Function declined in all three groups over the same time-period. In conclusion, overall QoL in ALS does not appear to change after NIPPV or PEG. This may reflect the impact of non-health-related factors or may be due to a response shift. QoL instruments that include domains outside of health status may not be sensitive to changes from single interventions. Larger, prospective studies are needed.

Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children

To investigate the effects of percutaneous endoscopic gastrostomy (PEG) feeding on gastro-oesophageal reflux (GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance (pH/MII). Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement. Prior to PEG placement (pre-PEG) a total of 183 GOR episodes were detected, 156 (85.2%) were non-acidic. After PEG placement (post-PEG) a total of 355 episodes were detected, 182 (51.3%) were non-acidic. The total number of distal acid reflux events statistically significantly increased post-PEG placement (pre-PEG total 27, post-PEG total 173, P = 0.028) and the mean distal pH decreased by 1.1 units. The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25 (0-2), post-PEG 2.95 (0-40)]. Average proximal pH was lower post-PEG but the within subject difference was not statistically significant (P = 0.058). Median number of non-acid GOR, average reflux height, total acid clearance time and total bolus clearance time were all lower pre-PEG, but not statistically significant. PEG placement increases GOR episodes in neurologically impaired children.

Effect of percutaneous endoscopic gastrostomy on gastrointestinal motility: evaluation by gastric-emptying scintigraphy

Firstly, to assess the effect of percutaneous endoscopic gastrostomy (PEG) tube placement on gastric emptying, gastrointestinal (GI) tract motility and the rate of gastroesophageal reflux (GER). Secondly, to confirm whether correlations exist between drug absorption behaviour and GI tract motility using the combination method of absorption function analysis with the motility study. Subjects comprised 11 patients with neurological dysphagia. Gastric-emptying scintigraphy was performed both before PEG via nasogastric tube feeding and after PEG placement. After fasting for more than 8 h, each patient was administered 111 MBq of 99mTc-labelled diethylenetriaminepentaacetic acid (DTPA) with a 100 ml liquid meal via a nutrition tube. Dynamic imaging was performed immediately after administration of a radiolabelled liquid meal for a 1 h period and static imaging was performed after 1, 2, 3 and 6 h. Gastric emptying half-time (T50) was calculated in each patient, and GER ratio and GI transit rate were also evaluated. Simultaneously, we administered 10 mg of famotidine in six of the 11 patients and measured serum concentrations of famotidine at 0, 1, 2, 3 and 6 h. Using the time-concentration curve of famotidine, the maximum concentration of famotidine (Cmax) and area under the curve of famotidine (AUCf) were calculated for each patient. In seven of 11 patients, T50 changed after PEG placement, but not significantly. The GER ratio was significantly decreased and complicated pneumonia improved after PEG placement. GI transit rate for each GI segment was unchanged after PEG placement. Significant linear correlations were identified between T50 and both Cmax and AUCf. Gastric-emptying scintigraphy with Tc-DTPA was effective in the evaluation of GI transit before and after PEG, as well as in assessing GER. Motility and famotidine absorption were maintained after PEG placement. Significant linear correlations were found between T50 and both Cmax and AUCf. These findings suggest that drug absorption may have some relationship between T50. The result may be more reliable with a larger population.

Effect of percutaneous endoscopic gastrostomy on gastro-esophageal reflux in mechanically-ventilated patients

To investigate the effect of percutaneous endoscopic gastrostomy (PEG) on gastroesophageal reflux (GER) in mechanically-ventilated patients. In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilator-associated pneumonia (VAP) and GER > 6% were divided into PEG group (n = 16) or non-PEG group (n = 20). Another 11 ventilated patients without reflux (GER < 3%) served as control group. Esophageal pH-metry was performed by the "pull through" method at baseline, 2 and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue. A significant decrease of median (range) reflux was observed in PEG group from 7.8 (6.2 - 15.6) at baseline to 2.7 (0 - 10.4) on d 7 post-gastrostomy (P < 0.01), while the reflux increased from 9 (6.2 - 22) to 10.8 (6.3 - 36.6) (P < 0.01) in non-PEG group. A significant correlation between GER (%) and the stay of nasogastric tube was detected (r = 0.56, P < 0.01). Gastrostomy when combined with semi-recumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

Effect of Percutaneous Endoscopic Gastrostomy on Gastro-esophageal Reflux and Gastric Emptying

BACKGROUNDS: Percutaneous endoscopic gastrostomy (PEG) has gained broad acceptance as an effective method for achieving enteral access in patients who need chronic nutritional support. It was reported that gastro-esophageal reflux (GER) was less observed with PEG feeding as compared with naso-gastric tube feeding, and that the posture under feeding may affect GER. However, real change in GER before and after the PEG placement remains unknown. AIMS: We investigated GER using ambulatory pH monitoring, and gastric emptying before and after the PEG. The effect of posture while feeding on the GER was also evaluated. METHODS: Twenty patients (8 men and 12 women; mean age, 79.4 years) who need continuous nutritional support due to various diseases such as a stroke, were registered. Under the written informed consent from patients or their families, ambulatory 24-h esophago-gastric pH monitoring, and the gastric emptying test were performed before (with naso-gastric tube feeding) and 1 month after the PEG placement. Seventy-two hours before the monitoring, drugs which affect gastric acid secretion and/or gastric motility were stopped. The content and pattern of feeding through the tube were fixed. Gastric emptying time was determined by the paracetamol method in which serum acetaminophen level was measured 45 min after drinking the semi-liquid test meal (200 mL, 200 kcal) with acetaminophen (20 mg/kg). Some patients after PEG were fed at Fowler position on the first day and at supine position on the second day with 48-h pH monitoring. RESULTS: The mean of intra-esophageal pH was increased after PEG placement (before: 5.59±0.16, after: 6.05±0.21). The time ratio of intra-esophageal pH less than 4 was significantly decreased (before: 9.5±3.1%, after: 5.8±2.5%), suggesting that GER was less observed with PEG feeding. Gastric acidity evaluated by the mean intra-gastric pH and holding time ratio of intra-gastric pH more than 3, was not varied with PEG placement. Gastric emptying was delayed in patients as compared with those in healthy volunteers, but PEG did not modify gastric emptying. The posture under feeding did not affect GER, gastric acidity, and gastric emptying. CONCLUSIONS: GER was less observed with PEG feeding as compared with naso-gastric tube feeding, suggesting the advantage of PEG feeding in regardless the posture while feeding.

Effect of percutaneous endoscopic gastrostomy (PEG) feeding on dysphagia complications in elderly nursing home patients: A multi-center, retrospective, cross-sectional prevalence analysis

Effect of percutaneous endoscopic gastrostomy (PEG) feeding on dysphagia complications in elderly nursing home patients: A multi-center, retrospective, cross-sectional prevalence analysis

Effect of percutaneous endoscopic gastrostomy (PEG) feeding on dysphagia complications in elderly nursing home patients: A multi-center, retrospective, cross-sectional prevalence analysis

Effect of percutaneous endoscopic gastrostomy (PEG) feeding on dysphagia complications in elderly nursing home patients: A multi-center, retrospective, cross-sectional prevalence analysis

Effect of percutaneous endoscopic gastrostomy on gastric emptying in clinically normal cats

Abstract Objective To assess the effect of percutaneous endoscopic gastrostomy (PEG) tube placement on gastric emptying in clinically normal cats. Animals 8 healthy adult 3- to 5-year-old cats. Procedure Cats were accommodated to the diet for 2 weeks prior to scintigraphy. Caloric needs were divided into 3 feedings/d. Food was withheld for 24 hours after tube placement, then was fed as a third of the caloric needs on day 1, two-thirds on day 2, and full caloric requirements thereafter. Gastric emptying was measured via nuclear scintigraphy. Labeled meals contained 111 MBq (3 mCi) of 99mTc-labeled disofenin. Sixty-second ventral scintigraphic images were acquired immediately, every 20 minutes for the first hour, then every 30 minutes for 4 hours after feeding. Each cat was evaluated 3 times prior to PEG tube placement. Cats were anesthetized, and 16-F mushroom-tipped Pezzar gastrostomy tubes were placed, using a video endoscope. Scintigraphy was repeated on days 1, 4, 7, 11, 14, and 21 after PEG tube placement. Results Gastric emptying was faster with a PEG tube in place. Percentage of retained gastric activity was significantly lower after PEG for 150, 180, 210, and 240 minutes versus time before PEG tube placement. Conclusion Placement of a PEG tube does not delay gastric emptying in clinically normal cats. Clinical Relevance Gastric retention of food, vomiting, and aspiration pneumonia after PEG tube placement may not be related to delayed gastric emptying. (Am J Vet Res 1998;59:1414–1416)