Gastrostomy Tube Feeding Research Articles

ÇOCUKLARDA GASTROSTOMİ PROSEDÜRÜ ÖNCESİ VE SONRASI EBEVEYNLERIN TUTUMU, BAKIŞ AÇISI VE DENEYİMLERİ: KANTİTATİF ÇALIŞMALARIN SİSTEMATİK DERLEMESİ

It is important to understand caregivers’ need for support from healthcare provider and the effect of gastrostomy tube feeding (G-tube feeding) on the lives of children and their caregivers before and after gastrostomy procedure. This systematic review aims to identify the opinions, attitudes and experiences of the caregivers related with G-tube feeding. We reviewed quantitative studies in English that deal with opinions, experiences and attitudes of caregivers before and after children’s gastrostomy procedure. In consultation with a medical librarian, we reviewed quantitative studies on our subject that were published up to 10 May 2015 by using five electronic databases, namely, CINAHL, PubMED, PSYCINFO, SCOPUS and Ovid Cochrane database of Systematic Reviewsfor quantitative studies. The quality of reviewed studies was evaluated by using JBI Critical Appraisal Checklist for Observational Studies. We identified 1897 citations and only eight studies from the citation list met the inclusion criteria. Five studies collected data after G-tube placement whereas the remaining three studies collected data during both the pre-procedural and post-procedural period. In six of these studies, outcomes were assessed by using objective criteria. None of the studies used questionnaires, whose reliability and validity were assessed for the country that the studies were conducted at. Caregivers in five of these studies expressed positive outcomes, such as, decreasing stress levels, increased satisfaction for the children and their parents, and improvements in the quality of life and the communication between the children and their parents. Three studies found both positive and negative impacts of G-tube placement on the lives of children and caregivers. Factors, such as, difficulty in reaching a final decision on G-Tube placement, inadequate information provided by healthcare professionals, restricted mobility, stress related with G-tube feeding, insufficient postoperative education program, and fear of unintentional loss of the gastrostomy button, were expressed as negative outcomes of G-tube feeding. Although some studies state that feeding with gastrostomy tube facilitates the lives of children and caregivers, some studies show that the gastrostomy tube adversely affects the lives of children and families. As a result, healthcare professionals should tend to inform families about all aspects of the procedure during the gastrostomy procedure, knowing these positive and negative consequences from studies.

Retrospective study of complications associated with surgically-placed gastrostomy tubes in 43 dogs with septic peritonitis.

To determine the safety of surgically-placed gastrostomy feeding tubes in dogs with septic peritonitis. Retrospective analysis of 43 dogs with septic peritonitis that had undergone surgical exploration and gastrostomy tube (de Pezzer or Foley) placement as part of the surgical procedure. Postoperative recovery times, hospitalisation times, complication rates and overall survival times were documented. The most common cause of septic peritonitis was dehiscence of an enterotomy or enterectomy site. Fifteen dogs had a Foley gastrostomy tube placed and 28 had a de Pezzer gastrostomy tube placed. The median time from surgery to the start of enteral nutrition was 16 hours (range 3 to 28 hours). There were no major complications relating to the gastrostomy tube; minor complications occurred in 11 (26%) patients. The overall median time spent in hospital was 5 days (range 3 to 29 days) for patients surviving to discharge and 22 (51%) dogs survived overall. Gastrostomy feeding tubes provide a safe way to provide enteral nutrition to dogs with septic peritonitis; they are associated with a low complication rate in these patients.

1860 Use of NBT Gastrostomy Tubes as Replacement Jejunal Feeding Tubes

INTRODUCTION: For severely neurologically impaired patients, feeding tubes are a life-sustaining measure. While most patients can tolerate direct feeding into the stomach via nasogastric feeding tubes or gastrostomy feeding tubes, these options may be unhelpful or dangerous for patients with gastric retention or severe gastroesophageal reflux. For such patients, feeding through a jejunostomy may offer a safe alternative. However, when the tube needs to be replaced there are limited options. We review our experience of using non-balloon tip (NBT) gastrostomy replacement tubes as replacement jejunostomy tubes. CASE DESCRIPTION/METHODS: We searched procedure and follow-up reports from an individual gastroenterologist (JRE) from 03/2015 to 11/2018 for patients with jejunostomy feeding tubes at a single sub-acute nursing facility. All four jejunostomy patients on record had received 20 French NBT gastrostomy replacement tubes as replacement jejunostomy feeding tubes. The NBT tubes have a collapsible mushroom-shaped tip which is placed in the stoma with an obturator. We reviewed the patient records to determine if NBT replacement tubes effectively delivered nutrition and medication, whether they resulted in complications, and with what frequency the tubes needed replacement. DISCUSSION: The patients’ records show that the improvised replacement jejunal feeding tubes performed quite well. Available records show that the patients were fed jejunally for periods ranging from 47 to 168 weeks. Replacement NBT tubes lasted from 28 to 609 days. During this period, the only complication suffered was internal detachment of the mushroom tip, which occurred 5 times (4 of which in a single patient). In each of these cases however, the bowel remained unobstructed and the tips passed through the alimentary canal. Patients retained overall good health in spite of neurological impairment. For patients requiring feeding interventions, but lacking adequate gastric function, jejunostomy feeding is often needed if enteral feeding is to be maintained. While there is at present a dearth of equipment designed specifically for jejunal feeding tube replacement, our experience suggests that NBT gastrostomy tubes may constitute a viable option for patients with jejunostomy tubes. These mushroom-tip tubes remain in place without occluding the jejunum, they clog infrequently due to the wide lumen, and they represent a readily available and easy to place option for patients who need jejunostomy tube replacement.

Creation of a Standard Model for Tube Feeding at Neonatal Intensive Care Unit Discharge.

Feeding dysfunction is a common consequence of prematurity and illness in neonates, often requiring supplemental nasogastric (NG) or gastrostomy (GT) feeding tubes. A standardized approach to the discharge of infants receiving home enteral nutrition (HEN) is currently lacking. The Home Enteral Feeding Transitions (HEFT) program was developed to identify patients eligible for HEN and create a standard discharge process. A structured tool helped determine discharge timing and route, and a dedicated outpatient clinic was created for infants discharged on HEN. Demographic, inpatient, and outpatient data were prospectively collected and compared with a historical cohort. A total of 232 infants discharged from our neonatal intensive care unit (NICU) over 9 months met inclusion criteria. Ninety-eight (42%) were discharged with HEN, 68 NG and 30 GT, compared with 134 (58%) receiving full oral feeds. This represented a 10% increase in HEN utilization (P=0.003) compared with our historical control group. Median HEN length of stay was 31.5 days compared with our historical average of 41 days (P=0.23). Frequency of emergency department visits and admissions because of HEN was unchanged postintervention. Parents were satisfied (8.6/10), and 98% said they would choose HEN again. The median time to NG discontinuation after discharge was 13.5 days, with an estimated cost savings of $2163 per NICU day. Our program is the first of which we know to use a standard care-process model to guide the decision-making and utilization of HEN at NICU discharge. HEFT shows that HEN at NICU discharge can be safe and effective, with high parental satisfaction.

Toxicity and Pharyngeal Dysphagia Outcomes from Intensity Modulated Proton Therapy for Oropharyngeal Squamous Cell Cancer

To report acute and chronic toxicities, including swallowing outcomes, from intensity modulated proton therapy (IMPT) in patients treated for oropharynx squamous cell carcinoma (OPSCC). This study combines 2 prospective protocols evaluating IMPT in head and neck cancer. This analysis included OPSCC patients treated with IMPT as first course irradiation treated from May 2012 to July 2016. Toxicities were graded as per Common Terminology Criteria for Adverse Events version 4.01. In patients who underwent post-treatment modified barium swallow (MBS), the summary of pharyngeal dysphagia grade using the dynamic imaging grade of swallowing toxicity (DIGEST) scale, scoring swallowing function from 0 (no dysphagia) to 4 (very severe dysphagia). Overall survival (OS), locoregional control (LRC) and disease free survival (DFS) were estimated using the Kaplan Meier Method. 103 patients met the inclusion criteria. Median age was 61 years (range 37-84), 85% of patients were male, 92% had HPV-associated disease, and 44% were never smokers. Seventy percent of patients had concurrent chemotherapy, 30% had induction chemotherapy, and 7% had robotic surgery before IMPT; only 22% had IMPT monotherapy. As per AJCC 8th Ed, 63%, 19%, 10%, 7% and 1% of patients had stage I, II, III, IVA and IVB, respectively; while as per AJCC 7th Ed, 1%, 1%, 17%, 77% and 5% of patients had stage I, II, III, IVA and IVB, respectively. Median follow-up was 3.3 years (range 0.5-7.0 years). Acute toxicities were: grade 3 mucositis, grade 3 dermatitis, and grade 3 dysphagia in 46%, 43%, and 15% of patients. There were no grade 4-5 toxicities. Rate of gastrostomy (feeding) tube during therapy was 26%, for a median duration of 106 days (range 28-624). Rates of aspiration pneumonia and hospitalization per-treatment were 16% and 7%. In 41 patients who had post-therapy MBS, worst post-treatment DIGEST score was 0, 1, 2 and 3 in 29%, 37%, 27% and 7% of patients. OS, LRC, and DFS were 96% , 93%, and 93% at 3-years and 80%, 90%, and 77% at 5-years. 5%, 6% and 3% of patients has local, neck and distant failure. Stage I disease and absence of tobacco smoking history were associated with improved OS and DFS. This large prospective report of patients with OPSCC treated with IMPT demonstrates a safe toxicity profile with favorable swallowing outcomes. Our results support that IMPT for OPCSCC is well tolerated and yields excellent long-term cancer control outcomes.

Gastrostomy Tube Feeding in Extremely Low Birthweight Infants: Frequency, Associated Comorbidities, and Long-term Outcomes

To assess the frequency of gastrostomy tube (GT) placement in extremely low birth weight (ELBW) infants, associated comorbidities, and long-term outcomes. Analysis of ELBW infants from 25 centers enrolled in the National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-up Registry from 2006 to 2012. Frequency of GT placement before 18-22months, demographic and medical factors associated with GT placement, and associated long-term outcomes at 18-22months of corrected age were described. Associations between GT placement and neonatal morbidities and long-term outcomes were assessed with logistic regression after adjustment for center and common co-variables. Of the 4549 ELBW infants included in these analyses, 333 (7.3%) underwent GT placement; 76% had the GT placed postdischarge. Of infants with GTs, 11% had birth weights small for gestational age, 77% had bronchopulmonary dysplasia, and 29% severe intraventricular hemorrhage or periventricular leukomalacia. At follow-up, 56% of infants with a GT had weight <10th percentile, 61% had neurodevelopmental impairment (NDI), and 55% had chronic breathing problems. After adjustment, small for gestational age, bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, poor growth, and NDI were associated with GT placement. Thirty-two percent of infants with GTs placed were taking full oral feeds at follow-up. GT placement is common in ELBW infants, particularly among those with severe neonatal morbidities. GT placement in this population was associated with poor growth, NDI, and chronic respiratory and feeding problems at follow-up. The frequency of GT placement postneonatal discharge indicates the need for close nutritional follow-up of ELBW infants. ClinicalTrials.gov: NCT00063063.

当院での人工的水分・栄養補給法の変遷 －経皮経食道胃管挿入術導入と栄養サポートチームの活動－

当院での人工的水分・栄養補給法の変遷 －経皮経食道胃管挿入術導入と栄養サポートチームの活動－

Image-Guided Palliative Interventions

This article reviews a few surgical palliative care procedures that can be performed by surgeons and interventional radiologists using image-guided techniques. Treatment of recurrent pleural effusions, gastrostomy feeding tube maintenance, percutaneous cholecystostomy, and transjugular intrahepatic portosystemic shunts (TIPS) with embolotherapy of bleeding stomal varices is discussed.

A comparison of laparoscopic gastrostomy tubes and percutaneous endoscopic gastrostomy in infants: results from a single institution

Background/PurposeLaparoscopic gastrostomy (LG) and percutaneous endoscopic gastrostomy (PEG) are two common methods for gastrostomy feeding tube placement in children. There have been limited studies evaluating these surgical interventions in infants under 12 months of age. MethodsThis study is a retrospective review of 186 patients who underwent either LG or PEG placement over a 5-year period at a single institution. The primary outcome for this study was the complication rate between the two groups. ResultsOf 186 patients who underwent gastrostomy tube placements, n = 130 patients comprised the PEG cohort, and n = 56 made up the LG cohort. The demographics of the two cohorts were comparable in weight, age, and co-morbidities. The overall complication rate was 29.6% The breakdown of 31.5% complications in the PEG group vs. 25% in the laparoscopic group was not statistically different. However, the PEG group did have significantly more patients who required general anesthetic for additional procedures related to G tube placement. ConclusionLaparoscopy and endoscopy are both acceptable options for gastrostomy tube placements in infants. However, this study identifies that PEG placements are associated with significantly increased risk for the need of additional procedures requiring general anesthesia in this patient population.Level of Evidence

Evaluation of burden and depression among caregivers of stroke patients: The role of percutaneous endoscopic gastrostomy feeding tube

Malnutrition problems are very common after a stroke. Several clinical studies have shown the contribution of percutaneous endoscopic gastrostomy (PEG) feeding after stroke in terms of improving nutritional status and reducing mortality. The aim of this study is to compare the burden and depression among caregivers of ischemic stroke patients fed with PEG and orally. A total of 63 caregivers of patients with acute ischemic stroke who were followed up in the neurointensive care unit with modified Rankin Scale 4 or 5 were recruited in this cross-sectional survey. Clinical data of patients and demographical profile as age, gender, kinship to patient, income, and level of education of caregivers were recorded. On their 3rd-month follow-up visit, Beck Depression Inventory and The Zarit Burden Interview (ZBI) were administered to caregivers to evaluate depressive symptoms and caregiver burden. A semi-structured questionnairre was developed and conducted by the researchers with the caregivers to assess their thoughts of nutrition. Thirty-two caregivers of stroke patients on PEG and 31 caregivers of stroke patients who were fed orally were evaluated. The groups did not differ statistically in terms of demographic variables and depression scores (p>0.05). However, the mean score of ZBI was significantly higher in the group of caregivers of stroke patients who were fed orally (p=0.00). Caregivers of stroke patients on PEG had higher scores of caregivers' thoughts of nutrition support therapy questionnairre (p=0.00). Our findings demonstrate that caregivers of stroke patients report lower burden and higher level of positive thinking with PEG feeding than oral feeding. This suggests that nutritional care could include convenient and practicable methods for caregivers of patients with stroke in order to meet patients' nutritional requirements.

International Survey of Physicians' Perspectives on Percutaneous Endoscopic Gastrostomy Tube Feeding in Patients with Dementia and Review of Literature.

Percutaneous endoscopic gastrostomy (PEG) tube often remains to be used as a primary modality for feeding in patients with advanced dementia, perhaps due to misconceptions regarding the outcomes. Physicians' perceptions regarding the PEG tubes could be a significant contributing factor globally. A multidisciplinary approach involving the ethics committee can help address the issue. Our survey is focused on gauging physicians' perceptions regarding PEG tube utilization and its global impact on outcomes in dementia.

Nutritional Outcome in Home Gastrostomy-Fed Children with Chronic Diseases.

The aim of the study was to assess the anthropometric outcomes after gastrostomy tube (GT) placement in children with chronic diseases and the influence of primary diagnosis, age, and nutritional support. A longitudinal, multicenter, and prospective study was performed evaluating 65 children with GT feeding and chronic diseases (61.5% with neurological disease). Each child was evaluated three times (at baseline and at 6 and 12 months after GT placement) and the following data was collected: primary diagnosis, age at GT placement, anthropometry, and feeding regime. Repeated measures ANOVA were used to analyze the main effects (intra and intergroup) and the interactions effects on weight gain and linear growth at 6 and 12 months after GT placement. All patients significantly improved their body mass index (BMI)-for-age z-score (p < 0.001) and height-for-age z-score (p < 0.05) after 6 and 12-month of follow-up. BMI gain increased significantly the first 6 months, followed by a plateau, while height followed a linear trend. Children with GT placement before 18 months old experienced an accelerated growth rate during the first 6 months post-GT. This technique showed the effectiveness of GT placement improving nutritional status and growth catch up regardless of their primary diagnosis and the type of nutritional support.

Reversible conductive hearing impediments among patients with severe brain injury

Purpose: Rehabilitation of patients with severe traumatic brain injury may include auditory stimuli. Hampering the function of the external, middle ear or Eustachian tube generates a conductive auditory deficit up to 35 dB that may potentially hinder auditory rehabilitation. The objective was to evaluate the incidence of conductive hearing impediments among patients with severe brain injury.Methods: The cross-section study included adults with severe brain injury hospitalized in a rehabilitation center. The patients presented with a prolonged vegetative state, were dependent on mechanical ventilation and gastrostomy tube feeding. Assessment of external, middle ear and Eustachian tube included otoscopy, tympanometry, nasopharyngoscopy, gag reflex and soft palate evaluations.Results: Nineteen patients (38 ears) were evaluated: 14 males and 5 females, aged 18–93 years (average 59). All patients had a normal nasopharynx, lacked a gag reflex, palatal movements or supraglottic sensation. Eighteen ears (47%) had middle ear effusion, 26 (68%) ears had cerumen impaction, and 14 (37%) had both.Conclusions: Many patients with severe brain injury have reversible and treatable impairments that cause potential conductive hearing loss. Routine otoscopic examination and treatment if required, that is, removal of impacted cerumen or middle ear drainage, have rehabilitating and general health benefits.Implications for rehabilitationAuditory stimulation was suggested for rehabilitation in patients with severe traumatic brain injury.Many patients have cerumen and/or otitis media with effusion causing conductive hearing impairment as well as general health issues.Both aural impediments are diagnosed by routine otoscopy, are easily treated, and may affect rehabilitation.

Physician opinions on decision making for percutaneous endoscopic gastrostomy (PEG) feeding tube placement.

Percutaneous endoscopically placed gastrostomy (PEG) tubes are useful for long-term enteral nutrition; however, they are associated with lack of benefit for patients with advanced dementia, at end of life, and for some stroke patients with early regain of swallowing function. We surveyed physician opinions on decision making with the aim to identify factors that can lead to inappropriate PEG placement, as a first step of a quality improvement initiative to prevent inappropriate PEG placements at our facility. A survey was distributed to 231 physicians, with questions about discussion topics, contraindications, responsibilities, and practices in decision making for PEG placement. Five-point Likert scales were used for most responses. Of 62 respondents, the majority were general surgeons (51.6%) and neurologists (30.6%). Levels of agreement were very low that PEG placement is contraindicated in advanced dementia (> 56% disagreed) and at end of life (55% disagreed) with scores of 2.4 and 2.5 (out of 5), respectively. Agreement level was low (score of 2.85) for delaying PEG for stroke patients by at least 2 weeks. Agreement was high for the discussion topics, for allowing 1-7 days for processing information, and for consulting the nutrition service. Over 98% of respondents chose primary team and 58% chose both primary and endoscopy teams as being responsible for discussions with patients and care partners in the decision-making process. Greater awareness is needed of the lack of benefit of PEG feeding in advanced dementia, at end of life, and for some stroke patients with early regain of swallow function. Disagreement exists as to whether the primary team and endoscopist share in the responsibility for discussions in decision making for PEG placement.

Health care professionals' perceptions and experience of initiating different modalities for home enteral feeding

With an aging population, there is a concomitant increase in number of patients with dysphagia; and hence increase in prevalence of enteral feeding. Health care professionals play a critical role in informing decisions of patients and caregivers on their choice of modality for long-term home enteral feeding. To explore the perceptions of health care professionals on different modalities for enteral feeding and their experiences in initiating long-term enteral feeding among adult patients. A qualitative explorative descriptive study design with purposive sampling approach was adopted. A total of four speech therapists, fifteen nurses and seven doctors who were ever involved in initiating long term home enteral tube feeding were recruited over a data collection period of August to December 2017. One to one interviews were conducted and audio-recorded. An inductive content analysis approach, with open coding, creation of categories and abstraction of data was adopted. Four main themes were generated: (1) Naso-gastric Tube Feeding (NGT) is health care professionals' first choice of modality; (2) Percutaneous Endoscopic Gastrostomy Tube Feeding (PEG) is regarded as an alternative approach; (3) Perceived better outcomes with PEG; and (4) Identified barriers to promotion of PEG. NGT remained as the modality of choice although health care professionals perceived that patients will have better outcomes with the use of PEG.

Paediatric emergency department presentations due to feeding tube complications in children with cerebral palsy

To describe the characteristics of emergency department (ED) presentations due to complications from gastrostomy or gastrojejunal feeding tubes among children with cerebral palsy (CP), the complexity of complications and the management approaches taken. The Victorian CP Register was linked to the ED databases of Victoria's two tertiary paediatric hospitals, and data on presentations due to feeding tube complications were identified based on discharge diagnosis codes. Additional data on presentations were extracted from medical records. Over 5 years, there were 234 ED presentations due to feeding tube-related complaints among a CP cohort (n = 2183). ED notes were located for 183 of the 234 presentations. The majority of presentations (90%) involved children with severe gross motor impairment. A total of 46% of presentations (n = 84) was triaged as lower urgency, and 68% (n = 124) took place between 08:00 am and 06:00 pm. The most common presenting complaint was tube dislodgement (n = 105; 70%). No investigations were recorded in the majority of cases, and in almost 90% of cases, the feeding tube was successfully replaced in the ED, usually by an ED physician (n = 74) and less frequently by a surgeon (n = 9), gastroenterologist (n = 2) or nurse (n = 8); 9% (n = 17) resulted in a hospital admission. Most ED presentations due to feeding tube complaints in children with CP are in children with severe gross motor impairment but are able to be managed in the ED. As such, it is likely that care givers and other health professionals could manage some of the complications experienced in primary health-care settings closer to home.

Evaluation of the selection of patients for percutaneous gastrostomy feeding tubes

Evaluation of the selection of patients for percutaneous gastrostomy feeding tubes

Current Approaches to the Treatment of Gastroesophageal Reflux Disease in Children with Neurology

The incidence of gastroesophageal reflux in children with neurological disorders is more common than in the rest of the pediatric population. The risk of reflux development in these children is due to abnormal motility of the gastrointestinal tract, their long term staying in bed (a horizontal position), a disruption of the swallowing process, a delayed evacuation of food from the esophagus and stomach, and a weakened muscle tone that pose a serious threat to a patient by possible complications (such as reflux esophagitis, peptic stricture, erosion and bleeding), and sometimes being one of the causes of death. From 2008 to 2018, 128 patients with gastroesophageal reflux disease were hospitalized in the Department of Surgery of the Scientific Center for Pediatrics and Pediatric Surgery including 33 (26%) children with neurological disorders, of which 28 (85%) were operated. All of the patients underwent Nissen esophagofundoplications, of which in 21 (75%) children it was combined with Stamm gastrostomy and in 18 (64%) children with Mikulich pyloroplasty. The results of surgical treatment were analysed in all the 28 patients in the early period (7-14 days) after surgery. In 2 (7%) children who did not undergo the pyloroplasty there was a complication in the form of gastric distress syndrome, which required an additional surgery in order to drain the stomach. A relapse of gastroesophageal reflux disease was observed in 1 (4%) patient who was re-operated. In the remaining 25 (89%) children, the postoperative period was favourable. Their gastrostomy tube feeding was carried out according to the age requirements. The long-term results were studied in time interval from 6 months to 3 years after surgery. X-ray control examination, fibroendoscopy and 24-hour pH monitoring were conducted in all children in the distant period. The results of the treatment are favourable, the weight deficit is filled, the reflux esophagitis is stopped and the reflux-associated inflammations of the bronchopulmonary system are reduced. To a large extent, the choice of operational tactics can be adapted to the condition of a particular child, the results of objective and instrumental tests for GERD, the pseudobulbar disorders and associated pyloric functional disorders. Timely correction of reflux disorders in children with pathologies of the central nervous system helps prevent the development of serious complications, which will inevitably improve a child’s quality of life.

Effects of nasogastric and percutaneous endoscopic gastrostomy tube feeding on the susceptibility of pulmonary infection in long-term coma patients with stroke or traumatic brain injury

Objective: To investigate the effects of nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) tube feeding on the susceptibility of pulmonary infection in long-term coma patients with stroke or traumatic brain injury. Methods: A total of 295 candidates who were in long-term coma after stroke or traumatic brain injury but without pulmonary infection and eligible for PEG catheterization were screened prospectively between January 2014 and February 2018. The patients were divided into PEG group (86 patients) and NGT group (209 patients) according to the choice of next-of-kin. Data related to the susceptibility of pulmonary infection were collected and analyzed in the two groups one month after the catheterization. Results: After follow-up for one month, compared with NGT group, patients in PEG group had a lower incidence of pulmonary infection (23.3% vs 37.8%, P=0.023), a later occurrence of pulmonary infection (average time: 21 days vs 13 days, P=0.034), and a less severe pulmonary infection (7.0% vs 12.9%, P=0.029). The following characteristics made patients more susceptible to pulmonary infection: age ≥ 70 years (HR=1.619, 95% CI 1.054-2.172), Charlson comorbidity index ≥ 2 points (HR=1.647, 95% CI 1.043-2.485), using of proton pump inhibitor ≥ 7 days (HR=1.725, 95% CI 1.214-2.738), and number of pressure ulcers ≥ 3 (HR=2.109, 95% CI 1.128-3.844). However, serum albumin concentration ≥35 g/L (HR=0.670, 95% CI 0.375-0.963) was a protective factor for pulmonary infections. The number of consistent pathogens cultivated from saliva, gastric juice and sputum simultaneously in NGT and PEG group was 35 strains (27.8%) and 8 strains (13.3%), respectively (P=0.029). The mortality of pulmonary infection was similar in the two groups (3.5% vs 4.3%, P=1.000), but the death due to pulmonary infection in the PEG group occur later (median time: 20 days vs 11 days, P=0.012). Conclusions: PEG feeding was a preferred nutrition way which could reduce the risk of pulmonary infection more effectively than NGT feeding which might favored a retrograde gastro-pulmonary route by which pathogens colonized in stomach migrated to respiratory tract. Patients with characteristics mentioned above had the susceptibility of pulmonary infection, thus risk assessment of pulmonary infection should be conducted before selecting the catheterization method.

Pilot Study of Pharyngoesophageal Dysmotility Mechanisms in Dysphagic Infants of Diabetic Mothers.

Swallowing difficulties are common in infants of diabetic mothers (IDM) and mechanisms are unclear. We tested the hypothesis that pharyngoesophageal motility reflexes are distinct in IDMs compared with healthy controls in a pilot study. Basal and adaptive pharyngoesophageal motility characteristics of 20 dysphagic IDMs and 10 controls were studied using purpose-built micromanometry system. During basal swallows, IDMs had lower frequency of deglutition apneas (62.5 vs. 95.4%) and longer active upper esophageal sphincter (UES) relaxation duration (0.8 ± 0.1 vs. 0.4 ± 0.1 second), whereas during adaptive swallows, IDMs had longer response latency to esophageal peristalsis onset (24.4 ± 2.1 vs. 9.7 ± 2.9 seconds) and longer lower esophageal sphincter nadir duration (28.9 ± 3.2 vs. 12.9 ± 4.6) (all p < 0.05) compared with controls. Nine in the IDM group needed gastrostomy feeding tube at hospital discharge versus none in controls. Feeding difficulties in IDMs are likely to be associated with maladapted or maldeveloped vagal neuropathy mechanisms manifesting as dysregulation of pharyngeal-airway interactions, longer active UES relaxation response, delays in the activation of esophageal contractile apparatus during peristalsis, and prolonged inhibition at the gastroesophageal junction.