Endoscopic Gastrostomy Tube Feeding Research Articles

Conservative recovery and replacement of a ruptured percutaneous endoscopic gastrostomy tube; a case report

BackgroundPercutaneous Endoscopic Gastrostomy (PEG) feeding tubes are frequently placed in patients to provide enteral nutrition. We report a case of a complete rupture of a PEG tube intra-abdominally with associated peritonitis after more than a month of PEG placement and utilization. To our knowledge, this is a very rare case of a complete PEG rupture with the succeeding replacement and recovery of the fractured segments conservatively.Case presentationA 69-year-old female with a PEG in position and in use for more than a month started complaining of severe abdominal pain. Digital subtraction angiography (DSA) tubogram revealed rupture and separation of the PEG tube into two fragments.Interventional radiology (IR) team was successful with their conservative approach. Both fragments were removed conservatively without the need for laparotomy. The distal fragment was utilized to place a guide wire, and a new PEG was placed in position with no intraabdominal leak.ConclusionRuptured PEG tube should be considered in the differential of patients complaining of sudden abdominal pain, especially after chronic PEG utilization. Conservative approach by IR is a viable option in correcting this mishap.

Use of percutaneous endoscopic gastrostomy (PEG) tube feeding support in head and neck cancer patients.

e18062Background: Insertion of percutaneous endoscopic gastrostomy (PEG) tubes for enteral feeding in patients with head and neck squamous cell carcinoma (HNSCC) undergoing multimodality therapy is...

PWE-225 Choice of enteral feeding tube in the non-surgical oncology setting: Abstract PWE-225 Table 1

Introduction Enteral nutrition (EN) may be indicated in non-surgical oncology patients if they are undernourished or cannot obtain adequate nutritional intake from the oral route alone. 1 The choice of feeding tube depends on several factors including gastro-intestinal (GI) tract accessibility, indication for EN and how long EN is required. Local resources such as access to gastroenterology and interventional radiology may also influence the type of tube inserted. The aim of this service evaluation was to determine the type of enteral feeding tube used in this population and their associated complications. Method We undertook a retrospective review of dietetic records between January 2013 and December 2014 for all patients who required home EN. Data was analysed descriptively. Head and neck and upper GI patients were excluded as this data is collected by separate specialist teams. Results 17 patients were initiated on EN at home during the data collection period. 12 patients had lung cancer, 2 lymphoma, 2 breast cancer and 1 colorectal cancer. Table 1shows the type and duration of feeding tube used. All the 11 patients fed for >30 days started with a NGT. 3 were eventually converted to gastrostomies, 4 were clinically unwell and never stable enough to be considered for a gastrostomy, for 1 patient gastrostomy insertion was contraindicated and 3 patients were predicted to respond sooner to treatment and resume oral intake. 10 (59%) patients experienced complications related to their feeding tube. Of those the most common complications reported were with NGTs. 5 patients (29%) had tubes replaced due to blockage or accidental falling out and 3 patients (18%) had repeated difficulties obtaining aspirates or pH of aspirates Conclusion There was heavy reliance on NGTs as a route of feeding including those requiring feeding for >30 days. It may be more appropriate to consider a gastrostomy insertion for those feeding medium to long term as these are commonly associated with less complications. 2 We encounter repeated problems with blocked NGTs and difficulties with obtaining gastric aspirates. We therefore need to review our practices in terms of information, training and ongoing support provided to patients in order to reduce these types of complications. Disclosure of interest None Declared. References Arends J, et al . ESPEN Guidelines on Enteral Nutrition: Non surgical oncology. Clin Nutr. 2006;25:245–259. Gomes J, et al . Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. The Cochrane Library, Issue 11, 2011.

A comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in prolonged dysphagic stroke patients

Objective To evaluate the effectiveness and the safety of percutaneous endoscopic gastrostomy (PEG) as compared with a nasogastric (NG) tube for adults with prolonged neurological dysphagia after stroke. Design A prospective case-controlled study. Patients and methods This study included 90 patients with severe neurogenic dysphagia categorized into two groups: those on PEG feeding and those on NG feeding because they refused PEG. A comparison of both groups was assessed by several methods. The primary outcome measures were death and aspiration pneumonia during 3 months' observation and the 2ry outcome measures were changes in the nutritional state during this period and patient and family satisfaction. Results Weight gain was significantly higher among patients in the NG group. The incidence of aspiration pneumonia was significantly higher among patients in the NG group (14) compared with seven patients in PEG. There were four (8.3%) deaths in the PEG group compared with eight (18.2%) in the NG group. Conclusion This study has demonstrated that PEG feeding in long-term dysphagic patients with stroke is associated with a significant reduction in the incidence of aspiration pneumonia with reduced mortality at 3 months. PEG is more acceptable and less irritating to patients and is superior in the delivery of feed and maintaining the nutritional status and improves the long-term quality of life.

Early experience with single-incision laparoscopic surgery for the placement of a gastrostomy in a 10-year-old girl: a case report

IntroductionAccess procedures for alimentation have been performed both endoscopically and surgically. In patients in whom endoscopic gastrostomy feeding tubes cannot be placed, single-incision laparoscopic surgery gastrostomy is an alternative method. This minimally invasive approach is a new technique performed through a single umbilical incision and without the need for additional laparoscopic ports.Case presentationIn this article we present a case of single-incision laparoscopic surgery gastrostomy performed with conventional laparoscopic instruments in a 10-year-old girl of Caucasian ethnicity who was not a candidate for a percutaneous endoscopic gastrostomy tube because of esophageal varices due to her advanced-stage cystic fibrosis with liver cirrhosis and portal hypertension. She also had an umbilical hernia, which was repaired during the same procedure through the same incision. Access and pneumoperitoneum were obtained through the umbilicus with the single-incision laparoscopic surgery port. The selected site for the feeding tube in the stomach was exteriorized through this incision and a feeding tube was placed. The stomach was returned into the abdomen. The fascial defect, and thus also the hernia, was repaired, and the 2cm umbilical incision was closed with endocutaneous sutures. The total operative time was 25 minutes. Our patient’s intra-operative and post-operative course was uneventful. We were able to use the feeding tube on the first post-operative day with good intestinal function. Our patient and her parents were pleased with the cosmetic result.ConclusionsThe single-incision laparoscopic surgery procedure seems to be a less invasive alternative to open placement of gastrostomy. This approach has the possible advantages of reduced post-operative pain, faster return to normal function, reduced port site complications, improved cosmesis and better patient satisfaction.

Ethics roundtable: 'Open-ended ICU care: Can we afford it?'

The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. For 3 months, he has been in status epilepticus (SE) on high doses of barbiturates, benzodiazepines, and ketamine and a ketogenic feeding-tube formula. He remains in burst suppression on continuous electroencephalography (EEG). He is trached and has a percutaneous endoscopic gastrostomy (PEG) feeding tube. He has been treated several times for pneumonia, and he is on a warming blanket and is on vasopressors to maintain his blood pressure. His vitals are stable and his lab work is within limits. The sedation is decreased under EEG guidance every 72 hours, after which he goes back into SE and heavy sedation is resumed. The latest magnetic resonance imaging (MRI) shows edema but otherwise no obvious permanent cortical damage. The family wants a realistic assessment of the likely outcome. The neurologist tells them the literature suggests the outlook is poor but not 100% fatal. As long as all of his other organs are functioning on life support, there is always a chance the seizures will stop at some time in the future, and so the neurologist recommends an open-ended intensive care unit (ICU) plan and hopes for that outcome.

A Retrospective Comparison of Percutaneous Endoscopic and Radiologic Gastrostomy Tube Feeding

A Retrospective Comparison of Percutaneous Endoscopic and Radiologic Gastrostomy Tube Feeding

In the Absence of Food

This study addresses the social and symbolic meaning of food and explores what happens on a micro/interactional level when people lose the ability to eat. Data are from open-ended survey research questions of patients with percutaneous endoscopic gastrostomy (PEG) feeding tubes as well as their families. Specifically, I draw on the symbolic interactionist perspective to understand the micro/interactional implications of food meaning and how such meanings are intrinsically connected to issues of identity. While eating and receiving proper nourishment are biological necessities for survival, the meanings surrounding eating and various food consumption practices extend far beyond mere nutritional consumption. Partaking in food consumption practices and rituals connects individuals to the societies in which they live. For PEG tube recipients, the loss of the ability to eat is experienced as a social loss and as an event that results in an undesirable change in their identity. Family members of patients with PEG tubes are also affected by this shift in their loved one's identity—indicating a spillover effect of stressful life events from one family member to another. The seemingly banal event of eating is discussed as an extraordinary social phenomenon.

Safety of percutaneous endoscopic gastrostomy (PEG) feeding tube placement in patients 90 years of age and older, a single center experience

Safety of percutaneous endoscopic gastrostomy (PEG) feeding tube placement in patients 90 years of age and older, a single center experience

Direct percutaneous endoscopic jejunostomy

Direct percutaneous endoscopic jejunal (DPEJ) feeding tube placement is a minimally invasive technique to facilitate enteral nutrition support. In many instances, DPEJ allows enteral nutritional access when other means are not feasible and in other instances effectively averts the risk of enterorespiratory aspiration. Although similar in principle to percutaneous endoscopic gastrostomy (PEG) feeding tube placement, it is a technically more demanding procedure. This report details the specifics of DPEJ placement. The indications, alternatives, risks, and published results of DPEJ placement are also reviewed.

Percutaneous endoscopic gastrostomy and nasogastric tube feeding (the prospective study in 30 dysphagic patients)

Percutaneous endoscopic gastrostomy and nasogastric tube feeding (the prospective study in 30 dysphagic patients)

Modified barium swallow does not affect how often PEGs are placed after stroke.

Dysphagia frequently follows stroke, but often resolves quickly. Percutaneous endoscopic gastrostomy (PEG) or other feeding tubes are placed to improve nutrition and hydration, and reduce the risk of aspiration pneumonitis. We evaluated the impact of modified barium swallow in determining PEG placements and the influence of specific swallowing abnormalities on PEG placement. The abnormalities assessed were presence of pharyngeal stasis and/or visualization of posterior pharyngeal transfer problems and aspiration of liquid or solids. A total of 302 patients with stroke were admitted to our hospital between 1989 and 1993, but only those with hemorrhagic or nonhemorrhagic stroke by computed tomographic (CT) scans or magnetic resonance imaging (MRI) or autopsy were included in our study. Patients with transient ischemic attacks (TIAs), central nervous system tumors, and traumas were excluded. Barium swallow studies were performed on 69 (23%) of patients; 49 (71%) were abnormal, based on aspiration of barium, pharyngeal stasis, or postpharyngeal transfer dysphagia. PEGs were placed in only 18% of those with abnormal studies. Of the patients with normal barium swallow studies, 25% had a PEG placed. Two hundred thirty-three patients underwent no barium swallow studies, but 11 (4.72%) of these had PEG placed. The rate of PEG placement was not related to any one of the abnormalities noted on the modified barium swallow. Rather, patients who received PEG had significant neurological deficits and increased prevalence of aspiration pneumonitis. The decision to insert PEG was made on clinical grounds and not on abnormal barium studies alone.

Randomized comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia RHR PARK, MC ALLISON, J LANG, ET AL Gastroenterology Units, Western and Royal Infirmaries and Stobhill Hospital, Glasgow, Scotland

Randomized comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia RHR PARK, MC ALLISON, J LANG, ET AL Gastroenterology Units, Western and Royal Infirmaries and Stobhill Hospital, Glasgow, Scotland