Enteral Feeding In Patients Research Articles

A Novel Method of Nasojejunal Feeding and Gastric Decompression Using a Double Lumen Silicone Tube for Upper Gastrointestinal Obstruction.

Provision of enteral nutrition with jejunal feeding in upper gastrointestinal obstruction is highly recommended. Access to jejunum can be obtained surgically, percutaneously, or endoscopically. Our institution routinely and preferentially utilizes a silicone nasojejunal tube that is inserted past the obstruction endoscopically. We use a custom dual channel tube that allows feeding at the distal tip and another channel 40 cm from the tip that enables decompression proximally. This is a report of our experience with this custom nasojejunal tube. This is a prospective observational study of 201 patients who underwent endoscopic nasojejunal wire-guided feeding tube insertions for obstruction of either the esophagus or the stomach including both benign and malignant pathologies between January 2015 to June 2018 in Hospital Sungai Buloh and Hospital Sultanah Aminah, Malaysia. The indications for tube insertion, insertion technique, and tube-related problems were described. The nasojejunal tube was used to establish enteral feeding in patients with obstructing tumors of the distal esophagus in 65 patients (32.3%) and gastric outlet obstruction in 72 patients (35.8%). There were 54 patients (26.9%) who required reinsertion. The most common reason for reinsertion was unintentional dislodgement, where 32 patients (15.9%) followed by tube blockage 20 patients (10.0%). Using our method of advancement under direct vision, we had only 2 cases of malposition due to severely deformed anatomy. We had no incidence of aspiration in this group of patients and overall, the patients tolerated the tube well. The novel nasojejunal feeding tube with gastric decompression function is a safe and effective method of delivery of enteral nutrition in patients with upper gastrointestinal obstruction. These tubes if inserted properly are well tolerated with almost no risk of malposition and are tolerated well even for prolonged periods of time until definitive surgery could be performed.

Percutaneous endoscopic gastrostomy: The Benin experience

Background: Percutaneous endoscopic gastrostomy (PEG), a gastrointestinal access, is one of the means of ensuring the sustenance of enteral feeding in patients who cannot swallow or eat. The procedure of PEG in the University of Benin Teaching Hospital (UBTH) is new with increasing acceptance by the clinicians and patients as it reduces morbidity and fosters early discharge home.Aims/Objectives: The aim of this study is to identify the need and usefulness for PEG, audit the process in its initial introduction, and document patient outcomes.Patients and Methods: This was a prospective study done over a 4-year period (2015-2018) and included all consecutive patient referred for PEG in the endoscopic suite of UBTH. Patient demographics, indication for PEG, outcome of the procedure, and complications were entered into a pro forma and the data analyzed.Results: A total of 17 patients had PEG over a period of the study. The male-to-female ratio was 2:1. The age range was 35–94 years, with a mean age of 68.6 years. Cardiovascular accident was the most common indication for PEG (64%; 10 patients), whereas intracranial tumors were 12% (2 patients), and other indications, namely severe head injury, dementia, and sepsis were 6% (1 patient) each. All patients had a successful procedure. Surgical site infection occurred in one patient, whereas another patient had extrusion of the PEG tube 1 month after the procedure.Conclusion: PEG is a safe procedure. The authors advocate the routine use of PEG in patient who cannot eat, especially in a subset of cardiovascular accident patients to sustain adequate nutrition while reducing the morbidity associated with nasogastric intubation and hospitalization.

The 2-Minute Spontaneous Swallowing Screening Predicts Independence on Enteral Feeding in Patients with Acute Stroke

BackgroundIt is recommended that enteral feeding should be offered to patients with dysphagia estimated to be unable to take adequate diet orally within 7 days of admission after acute stroke, but there is no clear criterion for initiation of enteral feeding. Recent studies have reported that the frequency of spontaneous swallowing is useful in screening for dysphagia in acute stroke. The present study was aimed to investigate whether measurement of frequency of spontaneous swallowing for 2 minutes could predict independence on enteral feeding 1 week after admission in patients with acute stroke. MethodsPatients with acute stroke were subjected. Within 72 hours of stroke onset, the number of swallows for 2 minutes was measured by auscultation. Subsequently, 1-hour frequency of spontaneous swallowing was measured using a laryngeal microphone. Functional Oral Intake Scale (FOIS) was evaluated 1 week after admission. ResultsTwenty-six out of 40 patients were independent on enteral feeding 1 week after admission based on FOIS. The presence of spontaneous swallowing for 2 minutes had .89 sensitivity, .54 specificity to predict independence on enteral feeding 1 week after admission, whereas the 1-hour frequency of spontaneous swallowing had 1.00 sensitivity, .46 specificity. Logistic regression analysis demonstrated that the presence of spontaneous swallowing for 2 minutes was independent predictor for independence on enteral feeding 1 week after admission, independently of age, sex, and NIHSS. ConclusionsThe 2-minute spontaneous swallowing screening predicts independence on enteral feeding 1 week after admission in patients with acute stroke.

THE USE OF HIGH FLOW NASAL CANNULA (HFNC) IN CHILDREN WITH BRONCHIOLITIS AND TIMING OF SAFE ENTERAL FEEDING IN A PEDIATRIC IN PATIENT UNIT: A RETROSPECTIVE REVIEW

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: The use of HFNC as non- invasive respiratory support in children with bronchiolitis has increased over the last several years. Several studies have investigated enteral feeding safety while on HFNC. This study investigates the safety of oral feeding prior to and following implementation of a HFNC feeding protocol. The purpose is to 1) Investigate safety of feeding in children with bronchiolitis on HFNC, 2) timing of enteral feeding initiation and quantify the HFNC flow for safe feeding. METHODS: A retrospective observational cohort study in children ≤2 years of age with bronchiolitis, requiring HFNC, from September, 2017 to January 15, 2019. Feeding complications were defined as increased work of breathing within one hour at start of feeding, vomiting, increased HFNC settings. Safety of enteral feeding was defined as absence of feeding complications. We recorded the timing of enteral feeding from the initiation of HFNC, duration of enteral feeding while on HFNC, and the flow of HFNC at which the feeding was initiated. We compare the data prior and post implementation of a HFNC feeding protocol. RESULTS: Descriptive statistics were calculated separately by pre and post protocol implementation. Comparison of two groups using the chi-square test for categorical variables and Mann-Whitney for continuous data and statistical significance at p<0.05 level. Analyses were performed using SAS version 9.4 (SAS Institute Inc. Cary, NC). Patients in both, pre- and post-protocol implementation groups have no feeding complications on HFNC. Subjects in Post (n=30) vs. Pre-Protocol Implementation (n=36) had a higher median amount of liters flow when initiating enteral feeding (8.0 vs. 6.0 respectively, p<0.024) and prolonged days on HFNC (4.0 vs. 3.0, p<0.030). Post-protocol implementation, enteral feeding was initiated sooner (days NPO 1.0 vs 2.0). No other significant differences between the two cohorts with respect to other variables were observed. (Table 1). CONCLUSIONS: Our data supports that enteral feeding in patients with bronchiolitis on HFNC is safe. Standardization due to current protocol, allowed safe earlier feeding of children on HFNC, reducing the time spent NPO. CLINICAL IMPLICATIONS: The use of HFNC offers an innovative alternative to traditional oxygen delivery and allows safe enteral feeding under the current bronchiolitis protocol at our institution. DISCLOSURES: No relevant relationships by Meredith Akerman, source=Web Response No relevant relationships by Arsenia Asuncion, source=Web Response No relevant relationships by Thomas Conway, source=Web Response My spouse/partner as a Employee relationship with Siement Healthiniers Please note: >$100000 Added 03/15/2019 by Claudia Halaby, source=Web Response, value=Salary

2143 A Unique Complication of Gastrostomy Tubes

INTRODUCTION: In 1979 the Gauderer-Ponsky technique was developed to allow endoscopic placement of gastrostomy tubes (G-tubes). The procedure allowed fistulation between the stomach and abdominal wall. G-tubes are often placed for enteral feeding in patients who have either an inability or insufficiency of intake by mouth. Complications of G-tubes are often seen but an overwhelmingly majority of them are minor. At times G-tubes lead to soft tissue &amp; skin infections, colocutaneous fistulas, &amp; visceral perforations. These more serious complications can occur up to 11-15%. Smaller complications such as dislodgement or G-tube dysfunction are far more common. CASE DESCRIPTION/METHODS: A 49 year-old male with a past medical history of traumatic brain injury with placement of a percutaneous endoscopic gastrostomy tube (G-tube) who presented to the ED after pulling out his G-tube. Unable to place the G-tube back at bedside, interventional radiology reinserted under fluoroscopy. After discharge he presented back to the ED with coffee ground emesis &amp; aspiration. He was noted to have klebsiella pneumonia. Despite being appropriately treated for his pneumonia he continued to have worsening septic shock abdominal distention. CT imaging was positive for large collection of fluid, gas, &amp; contrast filling his peritoneum. Emergent exploratory laparotomy found 6L of peritoneal fluid &amp; a perforated fistulous tract draining into his peritoneal cavity. Meanwhile his abdominal viscera was coated with a white film. Labs &amp; cultures confirmed peritonitis caused by klebsiella, enterococcus, &amp; candida. He received antibiotics and antifungal therapy, required multiple washouts, &amp; surgical correction of the perforation with a wedge gastrectomy. DISCUSSION: This patient developed a rare &amp; serious complication after G-tube placement. Dislodging the G-tube in a traumatic fashion caused drainage into his peritoneum. Even though the G-tube was replaced under radiographic guidance he developed a terrible case of peritonitis. The rates of complications are statistically the same in radiographically or endoscopically placed G-tubes. This patient required surgical placement of another G-tube along with and a wedge gastrectomy. This complication of fungal peritonitis &amp; aspiration pneumonia show us that G-tubes are not always benign. Endoscopic, surgical, and radiographic techniques may all have a different approach to ensure good outcomes but a patient’s ability to receive good G-tube care is essential in preventing long term complications.

MON-LB695: Comparison of Tolerance Continuous and Intermittent Enteral Feeding in Patients After Cardiac Arrest

MON-LB695: Comparison of Tolerance Continuous and Intermittent Enteral Feeding in Patients After Cardiac Arrest

Effectiveness and safety of perioperative enteral feeding in patients with burn injuries: a systematic review protocol.

The objective of this review is to determine whether perioperative enteral feeding improves outcomes in patients with burns. Literature has identified many positive benefits of nutrition support for patients with burn injuries, including preservation of lean body mass, improved wound healing, reduced gastrointestinal permeability and enhanced immunity. Fasting for surgery can undermine the nutritional care of these patients by causing nutrient deficits. It may also negatively affect patient well-being and insulin resistance. Perioperative fasting is intended to protect patients from regurgitation and pulmonary aspiration. This research aims to investigate whether perioperative feeding impacts outcomes in patients with burn injuries. This systematic review will consider studies whose participants have a burn injury. The intervention is perioperative enteral feeding (either intragastric or post-pyloric). Patients who received perioperative feeding will be compared with patients who had enteral nutrition withheld during the perioperative period. A number of outcome measures will be investigated, including mortality, length of stay, wound infection, wound healing rate and aspiration pneumonia. The key databases searched will be PubMed, CINAHL, Embase, Web of Science and Cochrane Central Register of Controlled Trials and Scopus. Only studies published in English will be considered. There will be no date limits. Full texts of selected studies will be retrieved and assessed against inclusion criteria. Studies that do not meet the inclusion criteria will be excluded, with reasons provided. Data synthesis will be pooled in a statistical meta-analysis. Subgroup analysis will be conducted where possible. Where statistical pooling is not possible, the findings will be presented in narrative form. PROSPERO CRD42018119034.

Percutaneous Endoscopic Gastrostomy Tube Placement: A Single Center Experience

Abstract Introduction Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the recommended methods for providing enteral feeding in patients with swallowing difficulty and intact gastrointestinal tract. We review our three years of experience pertaining to PEG placement in our hospital. Methods Records of all the patients, who underwent PEG between May 2014 to September 2017, were reviewed and relevant clinical and procedural details were noted. For all the patients, the procedure was conducted under antibiotic prophylaxis, moderate sedation, and local anesthesia. The PEG tube was placed by the “pull up” method. Telephonic follow-up of the patients was carried out after one month of study completion. Results The PEG tube was placed in 73 patients (male 51 [69.9%]; age median [range] 67 [16–91] years). PEG was placed in 42 patients with stroke (57.6%), other neurologic disorders 17 (23.3%), coma due to head injury 5 (6.8%), and terminal malignancy 9 (12.3%). Technical success was achieved in 73 (97%) patients. Eleven procedure-related complications occurred in nine patients (15.5%) including one death due to peritonitis. Of the 57 patients, who could be followed-up after discharge, 41 died of their primary illness after 65 (1–751) days, nine were alive and continuing on PEG tube feed, and in seven PEG was removed because it was not needed. Conclusion PEG is a useful procedure for enteral feeding. Although procedural success is high, it may be accompanied by significant complications.

Early removal of nasogastric tube with early feeding versus conventional removal of nasogastric tube with delayed feeding after bowel anastomosis: a prospective randomized controlled trial

Background: Nasogastric (NG) decompression and delayed oral feeding after bowel anastomosis is conventional and years old practice. The aim of the present study was to evaluate the advantages and disadvantages of early removal of naso gastric tube (&lt;24 hrs) and delayed feeding, compared with delayed removal and delayed enteral feeding in patients undergoing bowel anastomosis.Methods: It is a single blind, prospective randomized study involving patients with bowel anastomosis from December 2016- November 2018 at a tertiary care hospital. In study group naso gastric tube was removed within 24 hours. After 12 hours of surgery patients were allowed sips of water, then free liquids followed by semisolid and normal diet in calculated way. In control group naso gastric tube was retained till passage of flatus and orally allowed only after passage of stool.Results: A total of 241 patients were enrolled. In study group bowel sound returned after 30.57±31.19 hours of surgery and in control group 46.90±48.65 hours and this difference was significant (p&lt;0.002). In study group first free liquid was allowed on 38.14±38.50 hours in post operative period, as compared to the control group where free liquids were allowed after 50.09±51.80 hours this difference was significant (p&lt;0.04). Total hospital stay in the study group was significant (p&lt;0.02).Conclusions: Early removal of naso gastric tube and early feeding is better than the conventional practice.

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...

Abstract No. 701 Percutaneous radiologic gastrostomy/gastrojejunostomy placement without nasogastric access: US-guided gastric puncture technique and evaluation of feasibility and safety

Gastrostomy/gastrojejunostomy needs for enteral feeding in patients with high-grade narrowing or obstruction by variable cause. But stenosis or obstruction of upper GI tract itself makes impossible to pass the endoscopy or NG tube placement for conventional gastrostomy/gastrojejunostomy. We introduce the new technique, that is US-guided gastric puncture without NG tube placement for stomach inflation and evaluate the feasibility, safety, technical/clinical success and complication of that technique. From January 2013 to April 2014, 11 patients with high-grade stenosis or obstruction of upper GI tract who underwent percutaneous radiologic gastrostomy or gastrojejunostomy without NG tube placement were enrolled in this study. USG guided gastric puncture was performed with 21G Chiba needle, normal saline is infused in the stomach, alternative for air insufflation by NG tube. After then US-guided puncture for gastropexy and tube insertion was performed. Next step is same with conventional percutaneous radiologic gastrostomy/gastrojejunostomy. We successfully puncture in all patients with two attempts for one patient due to slipping out of the Chiba needle from stomach to the peritoneal cavity in the process of saline infusion. All patients were able to do enteral feeding through gastrostomy/gastrojejunostomy tube. There is no minor or major complication after the procedure. US-guided gastric puncture for percutaneous radiologic gastrostomy or gastrojejunostomy is feasible and safe technique.

Pressure Gastric Ulcer From an Over-Inflated Gastrostomy Tube Balloon: An Unusual Cause of Upper Gastrointestinal Bleeding

Percutaneous endoscopic gastrostomy (PEG) is one of the most commonly performed endoscopic procedures used for the establishment of enteral feedings in patients with dysphagia and in the elderly population with poor oral intake. Approximately 160,000-200,000 endoscopic PEG tube placement are performed each year in the United States. Despite its high success rate (>95%), major complications have been reported in 1% to 3% of cases. Endoscopically placed PEG tubes are more durable and longer lasting because an internal bumper of the tube holds the gastric wall firmly against anterior abdominal wall. This prevents easy dislodgement of the tube and minor leakage around the stoma. Dislodged endoscopic PEG tubes with a mature gastro cutaneous fistula can be replaced at the bedside with a PEG tube with a balloon. This avoids the need for a repeat endoscopy. Though cost effective the clinician should be properly trained about proper technique to avoid adverse outcomes. One such outcome is described in this case report. 80-year-old female with dementia and multiple co-morbidities presented from a nursing home with complaints of hematemesis and bleeding around PEG tube. Clinically she was noted to be tachycardic (HR 113 bpm), febrile (100.6 degrees). Blood work revealed anemia (Hgb 6.8 gm/dl) and high Blood Urea Nitrogen. On exam, a 22 Fr balloon PEG (15 cc balloon) with dried blood in and around the tubing was observed with melena on rectal exam. EGD revealed a large gastric ulcer with a visible vessel at the point of contact with an overinflated balloon. The internal balloon of the PEG tube appeared to be overinflated (at least 25 cc in a 15 cc balloon), compressing and ulcerating the stomach wall at the area of contact between the balloon and the gastric wall (Figure 1). Successful hemostasis was achieved endoscopically and a new bumper PEG tube placed under endoscopic guidance. Overinflated PEG tube balloon resulting in a large gastric pressure ulcer is an uncommon etiology of upper GI bleeding. This report can be used to emphasize the importance of following the PEG tube manufacturers recommendations and exercise proper technique and caution.Figure: Internal balloon of PEG appeared to be overinflated and compressing the stomach wall in area of ulcer.

Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?

Background: Percutaneous endoscopic gastrostomy (PEG) placed in the pull through (PT) technique is a common procedure to restore enteral feeding in patients with swallowing disorders. Limitations of this technique are patients with obstruction of the pharynx or esophagus or with an esophageal stent. We report our experience with the direct puncture (DP) PEG device. Methods: We included 154 patients (55 women). One hundred forty patients had cancer. After passing the endoscope into the stomach, 4 gastropexies were performed with a gastropexy device and the PEG was placed with the introducer method. After 1 month, the sutures were removed and a constant gastrocutaneous fistula had been created and the new catheter could be placed safely. Results: The DP PEG was successfully placed in all patients. Overall complication rate was 11% (minor: 6%, major: 5%). The most common event was tube dislocation (40 cases). In 5 cases of dislocation, this resulted in a major complication with injuring the gastric wall and the necessity for surgical treatment. Conclusions: The DP PEG system is safe, and can be used in cases in which a standard PT PEG is not feasible. To avoid dislocation, strict adherence to a post-interventional protocol is highly recommended.

The Effects of Early Enteral Feedings in Patients With Gastroschisis

The Effects of Early Enteral Feedings in Patients With Gastroschisis

Early Enteral Feeding After Living Donor Liver Transplantation Prevents Infectious Complications: A Prospective Pilot Study.

Infectious complications, including bacteria, virus, and fungus, often occur after liver transplantation and are the most frequent causes of in-hospital mortality. The current study prospectively analyze the effect of early enteral feeding in patients after living donor liver transplantation (LDLT)Between January 2013 and August 2013, 36 patients underwent LDLT. These patients were randomly assigned to receive enteral formula via nasointestinal feeding tubes [enteral feeding (EN) group, n = 17] or maintenance on intravenous fluid until oral diets were initiated (control group, n = 19). All patients completed the study.The pretransplant and perioperative characteristics of patients did not differ between the 2 groups. The incidence of bacterial infection was significantly lower in the EN group (29.4%) than in the control group (63.2%) (P = 0.043). In addition, the incidence of bile duct complications in the EN group was lower than in the control group (5.9% versus 31.6%, P = 0.041). Multivariate analysis showed that early enteral feeding was closely associated with bacterial infections (odds ratio, 0.178; P = 0.041). There was no statistically significant difference in nutritional status between the 2 groups. There were no cases of in-hospital mortality.Early enteral feeding after LDLT prevents posttransplant bacterial infection, suggesting the possibility of a reduction of in-hospital mortality as a result of decreased infectious complications.

Got milk? Effects of early enteral feedings in patients with gastroschisis.

Initiating early enteral intake post-surgical gastroschisis repair may result in better patient outcomes. However, there is lack of evidence and consistency in clinical practice regarding the timing of initiation of feedings, and few studies have determined best practices for post-operative nutritional management. To determine whether early nutritional management using a standardized advancement protocol improves outcomes for patients with gastroschisis. A retrospective study was used, following the implementation of a new early enteral feeding protocol. Patients managed without the new protocol, from January 2007 through December 2009, formed the traditional feeding group, while those receiving post-protocol nutritional management, from January 2010 through December 2012, comprised the early enteral feeding group. The main outcome, measured by length of stay (LOS), and secondary outcomes, including incidence of sepsis, were evaluated; N = 32. There was a statistically significant difference in the scores for LOS (P = .022) and incidence of sepsis (P = .36). No correlation was found between the number of days to initial feeding and LOS (P = .732). However, there was a robust, positive correlation between the number of days to achieve full feedings and LOS (P < .001) IMPLICATIONS FOR PRACTICE: These findings support the benefit of early initiation of enteral feedings in reducing the incidence of sepsis. Furthermore, they suggest the time to achieve full enteral feedings, not necessarily the timing of initiation of feedings, significantly impacts LOS. Consideration for future studies include incorporating strategies that combine early enteral feeding initiatives with interventions that allow for quicker onset of full enteral intake.

OC-087 Randomised trial of enteral feeding in patients discharged from hospital following surgical resection of an upper gastrointestinal malignancy

Introduction Patients undergoing upper gastrointestinal surgery often eat poorly post operatively, despite dietetic input. The benefit of nutritional supplementation following hospital discharge is unknown. We examined the benefit of 6 weeks nutritional supplementation via the patients feeding jejunostomy on fatigue, quality of life and independent living. Method Patients undergoing oesophagectomy or total gastrectomy for cancer had a feeding jejunostomy placed routinely at surgery. Jejunal feeding was started postoperatively and if tolerated at discharge consenting patients were randomly allocated (stratified by gastric/oesophageal) to nutritional supplementation (600 Kcal/day) via their feeding jejunostomies or no jejunal supplement. All patients received oral supplements and dietetic input. Patients were assessed at discharge and 3, 6, 12 and 24 weeks following discharge for fatigue (MFI-20), quality of life (EORTC QLQ-OES18), health economic analysis (independent living: EQ5D) as well as completing 2 day dietary diaries. Results were analysed non-parametrically (Mann-Whitney) and data presented as medians with interquartile ranges. Results 44 patients (M:F 29:15) were randomised, 23 received jejunal supplements. There was no difference between the groups in age, sex, neo-adjuvant chemotherapy, ASA grade, type of operation, operative time, blood loss, length of hospital stay, and inpatient complications. Percentage of calculated energy requirement actually received was greater in the supplemented group at weeks 3 and 6 (p Conclusion Dietary intake following hospital discharge after oesophageal or gastric surgery is poor. Addition of jejunal feeding over and above dietary advice and sip feeds is effective in providing patients with an adequate energy intake. Increased energy intake however, produced no obvious improvement in measures of fatigue, quality of life or health economics. Interestingly improvement in fatigue and independence plateaued by 12 weeks whilst there was little evidence of improvement in quality of life at 24 week. Disclosure of interest None Declared.

Age most significant predictor of requiring enteral feeding in head-and-neck cancer patients.

BackgroundA significant number of patients treated for head and neck squamous cell cancer (HNSCC) undergo enteral tube feeding. Data suggest that avoiding enteral feeding can prevent long-term tube dependence and disuse of the swallowing mechanism which has been linked to complications such as prolonged dysphagia and esophageal constriction. We examined detailed dosimetric and clinical parameters to better identify those at risk of requiring enteral feeding.MethodsOne hundred patients with advanced stage HNSCC were retrospectively analyzed after intensity-modulated radiation therapy (IMRT) to a median dose of 70 Gy (range: 60-75 Gy) with concurrent chemotherapy in nearly all cases (97%). Patients with significant weight loss (>10%) in the setting of severely reduced oral intake were referred for placement of a percutaneous endoscopic gastrostomy (PEG) tube. Detailed DVH parameters were collected for several structures. Univariate and multivariate analyses using logistic regression were used to determine clinical and dosimetric factors associated with needing enteral feeding. Dichotomous outcomes were tested using Fisher’s exact test and continuous variables between groups using the Wilcoxon rank-sum test.ResultsThirty-three percent of patients required placement of an enteral feeding tube. The median time to tube placement was 25 days from start of treatment, after a median dose of 38 Gy. On univariate analysis, age (p = 0.0008), the DFH (Docetaxel/5-FU/Hydroxyurea) chemotherapy regimen (p = .042) and b.i.d treatment (P = 0.040) (used in limited cases on protocol) predicted need for enteral feeding. On multivariate analysis, age remained the single statistically significant factor (p = 0.003) regardless of other clinical features (e.g. BMI) and all radiation planning parameters. For patients 60 or older compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (p = 0.0019).ConclusionsOlder age was found to be the most significant risk factor for needing enteral feeding in patients with locally advanced HNSCC treated with multimodal treatment. Pending further validation, this would support maximizing early nutritional guidance, targeted supplementation, and symptomatic support for older adults (>60) undergoing chemoradiation. Such interventions and others (e.g. swallowing therapy) could possibly delay or minimize the use of enteral feeding, thereby helping avoid tube dependence and tube-associated long-term physiologic consequences.

Potential Influence of Intravenous Lipids on the Outcomes of Acute Pancreatitis

Parenteral nutrition (PN) has been associated with a higher rate of adverse outcomes compared with enteral feeding in patients with acute pancreatitis (AP). However, PN may be necessary when feeding via the enteral route is poorly tolerated or impossible, and PN is recommended as a second-line nutrition therapy in AP. Intravenous (IV) lipids are commonly used as a part of PN in patients with AP. While the adverse outcomes related to the use of PN in AP have commonly been attributed to infectious complications, data suggest that the unsaturated fatty acids in the triglycerides used in IV lipids may contribute to the development of organ failure. We discuss the clinical and experimental data on this issue and the alternative lipid emulsions that are being studied.

Early Initiation of Enteral Feeding in Cancer Patients after Outpatient Percutaneous Fluoroscopy-Guided Gastrostomy Catheter Placement

PurposeTo report the results of early enteral feeding in patients with cancer after outpatient placement of a percutaneous fluoroscopy-guided gastrostomy (PFG). Materials and MethodsFrom January 2008 through December 2008, 121 consecutive patients with cancer underwent outpatient placement of a PFG for nutrition. Of these patients, 118 patients met criteria for early feeding, and 113 were successfully fed early (after at least 3 hours). Of the patients fed early, 5 had insufficient follow-up for further analysis leaving 108 patients for outcomes analysis. After placement of the PFG, patients were put on low-wall suction via the PFG for 1 hour followed by feeding via the PFG at least 3 hours after placement. Follow-up evaluation was done the next business day. The medical records were reviewed for 30-day outcomes of early feeding, technical aspects of the procedures, and complications. ResultsAfter placement of the PFG, 98% (118 of 121) of patients met criteria for early feeding, and 93% (113 of 121) of patients were successfully fed early. The median time between the end of the procedure and initiation of feeding was 4 hours (interquartile range, 3.7–4.4 h). The 30-day minor complication rate was 14% (15 of 108), and the 30-day major complication rate was 1% (1 of 108). No complications were directly attributable to early feeding. ConclusionsEarly initiation of tube feedings after outpatient placement of a PFG was well tolerated in patients with cancer and carried comparable risks to previously reported results using traditional delayed feeding protocols. Early feeding provided patients with prompt enteral nutrition and eliminated the need for routine hospital admission after the procedure.