Gastrostomy Tube Replacement Research Articles

The Pediatric Emergency Department Nurse and Gastrostomy Tube Replacement: How Safe Is it?

To review the outcomes of a nurse-only guideline for replacement of gastrostomy tubes (g-tubes) in a pediatric emergency department (ED) and compare rates of success, failure, length of stay (LOS), and return visits with that of ED physicians. Nursing g-tube guidelines, created by a nurse educator and nursing council, were instigated on January 31, 2018. Variables examined included LOS, age at visit, return visit within 72 hours, reason for replacement, and any postplacement complications. Data of g-tube placement by nurses and physicians were compared using t test or χ 2 analysis (IBM-SPSS version 20, New Orchard Road, Armonk, NY). The institutional review board determined the study to be exempt from human subjects. The STROBE checklist was used and completed accordingly. Chart abstraction and data were collected from January 1, 2011 through April 13, 2020, and medical records were obtained using International Classification of Diseases, Tenth Revision (ICD-10) codes for g-tubes: Z93.1, K94.23. A total of 110 patients were included in our study. Fifty-eight underwent nursing-only replacements; 52 were replaced by physicians. Nurse replacement success rate was 98.3% with an average stay of 22 minutes. Physician success rate was 100% with an average stay of 86 minutes. The difference between nursing and physician LOS was 64.6 minutes. No patient in either group experienced postreplacement complications. The initiation of nurse-only management of dislodged g-tubes was successful, safe, and had a shorter LOS when compared with physicians in the pediatric ED. Our study determined the implications of nurse-only replacement of g-tubes in a pediatric ED. We found that nurses replacing g-tubes was equally safe and effective as physician counterparts. In addition, we found that it significantly reduced the LOS for patients, which has consequences on patient satisfaction and billing. Nursing staff were trained in g-tube replacement using guidelines created by a nurse educator and nursing council. Patients either had their dislodged g-tubes replaced by the trained nurse or a physician and comparisons on the outcomes were made. Patients were aware of the study and consented to have their medical records accessed to make the data comparisons. With more than 189,000 children in the United States relying on g-tubes, nursing staff will inevitably be involved in the care of patients with such a device. In addition, as pediatric EDs continue to develop longer and longer waiting times, we must learn how to better use our nursing staff for procedures within their scope and minimize LOS. Our research demonstrates the safety, feasibility, and general benefits of having the pediatric nursing staff replace g-tubes in the ED, and it is hoped that this will lead to beneficial policy changes. - Demonstrates the safety and effectiveness of nurse-only g-tube replacement- Reports on the statistically significant difference in LOS between physician and nurse replacement of g-tubes in a pediatric ED- Has the ability to lead to policy change in the pediatric ED that will allow for greater patient satisfaction and decrease patient cost.

Percutaneous endoscopic gastrostomy tube replacement after head and neck surgery: A case report.

IntroductionPercutaneous endoscopic gastrostomy (PEG) has been available since the 1980s. Routine replacement is conducted at bedside with relatively few complications. Two replacement methods have come into practice: the percutaneous method and the endoscopic method. The laparoscopic method has recently become favorable in the pediatric population.Presentation of caseHerein, we describe a situation in which a gastrostomy tube was replaced at bedside on a patient with previous head and neck surgery for lingual cancer. The percutaneous traction method was used, and gastrostomy tube replacement into the gastric lumen could not be confirmed on subsequent imaging. The patient was ultimately taken to surgery for an open procedure where it was discovered that initial PEG placement had traversed the small bowel mesentery en route to the gastric lumen.DiscussionThe PEG tube is not a permanent device and routine exchange every 6–12 months is recommended. The percutaneous method and endoscopic method for gastrostomy tube replacement have both been used routinely, each with their set of complications. A third technique, laparoscopic placement, is the preferred modality in the pediatric population. Advantages are twofold: direct visualization of the stomach, thus eliminating inadvertent hollow viscus injury, and applicability in infants too small to undergo endoscopy necessary for PEG tube placement.ConclusionConsideration for laparoscopic placement or replacement in the head and neck cancer patient population, in which interval endoscopy is impossible, is thus advocated.

Factors affecting late complications of percutaneous endoscopic gastrostomy tube replacement.

Late complications associated with percutaneous endoscopic gastrostomy (PEG) tube in patients are common occurrences. We aimed to identify risk factors associated with PEG-related late complications. Patients who underwent PEG exchange were retrospectively collected from electronic medical records between January 2015 and November 2020. Medical records were reviewed longitudinally from the PEG replacement date until the first complication event, death, or the end of the study. The late complication was defined as the PEG-related complications six months after the initial PEG placement. Potential risk factors were tested using Cox proportional hazard. A total of 116 patients (mean age 80.5±17.6 years, 52.6% male) were enrolled with a 12 (4-23) months median follow-up. The indications were mostly neurologic disease (89.7%). Non-balloon PEG was used in 93 (80.2%) patients with balloon-type in 23 (19.8%) patients. PEG-related late complications developed in 35 (30.2%) patients with a median time of 9 (4-23) months. In the multivariate analysis, the PEG-related late complication rate was significantly higher in patients with balloon-type PEG tube (HR 5.54; 95%CI, 2.55-12.05; p<0.001) and also showed a significantly higher cumulative incidence of developing complications (54.9% vs. 12.8% at one year and 76% vs. 22.8% at two years, p<0.001). The most common complication was PEG dislodgement (n=14, 40%). Late-onset of PEG tube-associated complications is a common problem. The significant factor associated with PEG tube complication was balloon-type PEG placement.

Effects of frailty on postoperative clinical outcomes of aneurysmal subarachnoid hemorrhage: results from the National Inpatient Sample database

BackgroundThis study aimed to investigate the potential effect of preoperative frailty on postoperative clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH).MethodsData of patients aged 18 years and older who were diagnosed with subarachnoid hemorrhage or intracerebral hemorrhage, underwent aneurysm repair surgical intervention from 2005 to 2014. A retrospective database analysis was performed based on U.S. National Inpatient Sample (NIS) from 2005 to 2014. Frailty was determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. Patients were stratified into frail and non-frail groups and the study endpoints were incidence of postoperative complications and related adverse clinical outcomes.ResultsAmong 20,527 included aSAH patients, 2303 (11.2%) were frail and 18,224 (88.8%) were non-frail. Significant differences were found between frailty and non-frailty groups in the four clinical outcomes (all p < 0.05). Multivariate analysis showed that frailty was associated with significant higher risks of discharge to institutional care (aOR: 2.50, 95%CI: 2.10–2.97), tracheostomy or gastrostomy tube replacement (aOR: 4.41, 95%CI: 3.81–5.10) and postoperative complications (aOR: 3.29, 95%CI: 2.55–4.25) but a lower risk of death in hospital (aOR: 0.40, 95%CI: 0.33–0.49) as compared with non-frailty. Stratified analysis showed the impact of frailty on some of the outcomes were greater among patients younger than 65 years than their older counterparts.ConclusionsFrailty is significantly correlated with the increased risk of discharge to institutional care, tracheostomy or gastrostomy tube placement, and postoperative complications but with the reduced risk of in-hospital mortality outcomes after aneurysm repair. Frailty seems to have greater impact among younger adults than older ones. Baseline frailty evaluation could be applied to risk stratification for aSAH patients who were undergoing surgery.

Ultrasound is safe and highly specific for confirmation of proper gastrostomy tube replacement in pediatric patients

BackgroundGastrostomy tube (GT) dislodgement is a common cause of Pediatric Emergency Department (PED) visits. Postoperative patients and those who require stoma dilation are more likely to have complications during emergent replacement. Although incorrect replacement can cause significant morbidity overall, the occurrence is infrequent. Contrast injection of the GT is considered the standard for confirming proper placement. Case reports in both pediatric and adult patients suggest that ultrasound can be used to confirm proper replacement. The objective of the present study was to assess the utility of ultrasound to confirm GT placement in pediatric patients most at risk for complications from incorrect replacement. MethodsThis is a non-randomized cohort pilot trial to determine the sensitivity and specificity of ultrasound to confirm proper replacement of a GT in a Pediatric Emergency Department. ResultsWe enrolled 55 pediatric subjects, of which 50 had ultrasound imaging after GT replacement in the PED prior to contrast injection. Ultrasound was found to have 96% sensitivity and 100% specificity for confirming GT placement. ConclusionsUltrasound is a safe and reliable confirmatory study to confirm GT placement in pediatric patients, especially those at highest risk of complications from incorrect placement. Level of evidenceII

Scheduled percutaneous endoscopic gastrostomy tube replacement did not reduce PEG-related complications

Background Percutaneous endoscopic gastrostomy (PEG) tube insertion is used for enteral nutrition. Each manufacturer has its own instructions for planned tube replacement. Accordingly, caregivers have adopted the policy of elective change at a fixed period of time (3–6 months). Aim The current study aimed to assess whether retained PEG for more than 6 months was associated with a higher rate of PEG-related complications. Methods A retrospective single-center study included all patients who underwent PEG insertion were included in the study. Results Overall, 303 patients were included, 48 patients (16.2%) had PEG tube replacement. Peristomal PEG tube leak was the commonest complication, occurring in 20 patients (41.7%), followed by dislodgement in 18 patients (37.5%) and obstruction in 10 patients (20.8%). Among the patients with a leak, it occurred within and beyond 6 months from PEG insertion in 40 and 60% of patients, respectively (OR 0.68, 95% CI 0.21–2.18, p = .57). Similarly, 50% of patients had PEG tube obstruction within 6 months and 50% had it beyond 6 months from insertion (OR 1.46, 95% CI 0.34–6.26, p = .72). Moreover, there was no difference in PEG dislodgement after PEG insertion within or beyond 6 months (nine patients, 50% vs. nine patients, 50%), respectively, (OR 1.37, 95% CI 0.42–4.47, p = .76). Conclusion Retained PEG tubes for more than 6-months were not associated with more PEG-tube-related complications.

Transient Empty Portal Vein With Gastric Emphysema

An 88-year-old man who underwent gastrostomy was admitted for aspiration pneumonia. The patient used glucocorticoid and immunosuppressants for rheumatoid arthritis and interstitial lung disease. Two days after the gastrostomy tube replacement, the patient experienced abdominal pain and vomiting. His vital signs were stable, and only mild epigastric tenderness was noted. Blood tests revealed a white blood cell count of 9700 /μL, elevated C-reactive protein of 3.85 mg/dL, aspartate aminotransferase of 40 U/L, and alanine aminotransferase levels of 28 U/L.

"Cut and push" technique for a first gastrostomy tube replacement, a really safe alternative?

Rationale: The Cut and Push (CP) technique is a simple, accessible, and low-cost method to perform the first gastrostomy tube replacement.

Gastrostomy tube malposition during tube replacement

A 60-year-old man presented to the emergency department with diffuse abdominal pain hours after blind replacement of the gastrostomy tube, which had been inadvertently removed a day earlier. He had a history of motor neuron disease and a 24F PEG tube (Cook, Winston-Salem, NC, USA) placed 7 months previously (A). Initial examination revealed a narrowing lumen in the gastrostomy tract, which could accommodate only a 14F Foley catheter. A Kelly clamp was used to dilate the tract, and a 24F balloon replacement gastrostomy tube was placed (Cook).

Point-of-care ultrasound for confirmation of gastrostomy tube replacement in the pediatric emergency department.

Gastrostomy tubes (G-tubes) are frequently used in children for feeding and nutrition. Complications related to G-tubes (and G-buttons) in children represent a common presentation to the emergency department (ED). G-tube replacement is usually performed by pediatric emergency medicine physicians. Misplacement may lead to tract disruption, perforation, fistula tract formation, or feeding into the peritoneum. Contrast-enhanced radiographs are traditionally used for confirmation. In addition to a longer length-of-stay, repeat ED visits result in repeated radiation exposure. The use of point-of-care ultrasound (POCUS) instead of radiography avoids this exposure to ionizing radiation. Here, we describe three patients who presented with G-tube complications in whom POCUS alone performed by pediatricians was used for confirmation of the tubes' replacement. Two children presented to the ED with G-tube dislodgement, and one child presented with a ruptured balloon. In all three cases, a new G-tube was replaced at the bedside using POCUS guidance without the need for further radiographic studies. There were no known ED or clinic returns for G-tube complaints over the next 30days. This is the first report of pediatricians using POCUS to guide and confirm G-tube replacement in children. The success of these cases suggests the technique's feasibility. Future prospective studies are needed to evaluate the learning curves, diagnostic accuracy, ED length-of-stay, and use of confirmatory imaging.

Percutaneous endoscopic primary gastrostomy button (PEG-B) is safe and significantly reduces the need for general anaesthetic tube changes in children when compared to the percutaneous endoscopic gastrostomy tube (PEG-T): a prospective study

To compare the clinical outcomes and financial implications of the percutaneous endoscopic primary button gastrostomy (PEG-B) insertion using T-fastener technique with the percutaneous endoscopic gastrostomy tube insertion (PEG-T) using a push–pull technique. Data were prospectively gathered on 122 patients undergoing gastrostomy insertion over a 3-year period (2016–2019). Our primary outcome measure was the number of second general anaesthetics (GA) required in relation to the gastrostomy tube. Secondary outcome measures included complications and cost. Following exclusion criteria of lap assisted, concomitant procedure or insufficient data, 105 patients were analysed. Sixty-two (61%) PEG-B were inserted using a T-fastener technique. Forty-three (39%) PEG-T were inserted using a push–pull technique. Two (3.2%) patients with a PEG-B required a GA change or reinsertion of device compared with 31 (72%) of the PEG-T group who underwent a tube change under GA to either a button or a new tube in the study period (p < 0.01). The requirement for GA changes in the PEG-T group results in a considerably higher cost for this approach than the PEG-B approach. There was no difference between the number of peri-operative and post-operative complications between the two groups; however, the PEG-T group appeared to have higher rate of major operative complications (n = 3 bowel injuries). Whereas in the PEG-B group: complications were minor technical issues and displacement requiring replacement under fluoroscopy. In the follow-up period, rates of granulation tissue requiring intervention and stoma site infections were equivalent between groups. The PEG-B technique of placing a gastrostomy avoids the need for a replacement of gastrostomy tube under GA and its associated risk of repeat GA and financial cost. Furthermore, the technique is potentially associated with fewer major complications. We conclude, therefore, that the PEG-B approach reduces the interventional and financial burden on the patient, their family, and the healthcare provider, and could be considered as a safe alternative for paediatric gastrostomy insertion.

Gastric Outlet Obstruction Due to Malposition of Replacement Gastrostomy Tube.

A 78-year old male presented to the emergency department after accidental dislodgement of his chronic gastrostomy tube. A replacement gastrostomy tube was passed easily through the existing stoma and flushed without difficulty. Confirmatory abdominal radiography demonstrated contrast in the proximal small bowel, but the patient subsequently developed epigastric pain and refractory vomiting. Computed tomography revealed the tip of the gastrostomy tube terminating in the pylorus or proximal duodenum. This case highlights gastric outlet obstruction complicating the replacement of a gastrostomy tube and the associated radiographic findings.

2039. New York State 2016–2018: Progression from Candida auris Colonization to Bloodstream Infection

BackgroundNew York State (NYS) is experiencing a continuing outbreak of Candida auris, first identified in 2016. Patients who are colonized asymptomatically with C. auris can progress to bloodstream infection (BSI).MethodsColonized patients with positive nares or axilla/groin C. auris cultures were followed prospectively. Laboratories, hospitals and skilled nursing facilities reported C. auris clinical infections to the NYS Department of Health. Patient demographics, clinical history, hospital admission, procedures, and outcomes data were obtained using a standardized case report form. Patient-days were determined from date of first positive colonization to date of first positive clinical isolate, death, or March 30, 2018, whichever was first.ResultsBetween September 28, 2016 and March 30, 2018, 187 C. auris colonized patients were identified. Of these, seven progressed to BSI during at least 24,781 patient days of follow-up (median: 98 patient-days, range 0–548 days.) The median time from date of first colonization to date of BSI was 86 days (range 3–310 days). The median patient age at time of colonization was 71 years (range 57–89 years). Between colonization and BSI, patients had a median of five admissions in healthcare facilities (range 1–12). All patients had central neurologic disease, gastrostomy tubes, chronic wounds, and vascular lines at time of BSI. All patients had a positive culture for one or more other multi-drug resistant organism within 90 days of a positive C. auris culture, and all received antibiotics in the 30 days before BSI. Six (86%) patients received mechanical ventilation and had tracheostomies. Five (71%) patients had diabetes. Four (57%) had vascular lines replaced in the 30 days before BSI onset. Two (29%) cases had gastrostomy tube replacement between colonization and BSI. One patient died a week after C. auris BSI; a second died 4 months later.ConclusionIn NYS, 4% of C. auris colonized patients developed BSI, a rate of 0.3 BSI per 1,000 patient-days. BSI patients have portals of entry such as indwelling medical devices and wounds. Neurologic disease and diabetes may be risk factors for BSI. Meticulous aseptic technique for invasive procedures, device and wound care may help prevent C. auris BSI in colonized patients.Disclosures All authors: No reported disclosures.

Gastric Volvulus Caused by Gastric Tube Migration

Percutaneous endoscopic gastrostomy (PEG) is a procedure for providing enteral feeding and long-term enteral nutritional support in patients. Despite it being a well-tolerated procedure, there can be complications that have been described including ulceration, bleeding, infection, and aspiration. A potential late complication is a gastric outlet obstruction. We report a case where a patient was admitted for abdominal pain caused by migration of the gastrostomy tube balloon into the duodenal bulb causing volvulus. A 80-year-old male with a history of chronic dysphagia due to bulbar palsy presented to the emergency department with a 2 week history of abdominal pain and hematemesis that started two days ago. His PEG tube was placed a year ago replaced a month ago after it had clogged with a balloon type replacement gastrostomy tube. His hospitalization stay was otherwise unremarkable. The patient's vital signs were stable with a Temp was 97.5F, BP was 110/55, HR was 70. On auscultation bowel sounds were normal and there was no organomegaly noted. Laboratory findings were remarkable for hemoglobin of 9.3 g/dL (his baseline hemoglobin was 11-12 g/dL).A Computed Tomography of the abdomen and pelvis was unremarkable. An esophagogastroduodenoscopy performed later revealed grade A reflux esophagitis in the lower third of the esophagus with contact bleeding. In the gastric body the replacement gastrostomy tube was present and initially the balloon was seen to have migrated distally into the duodenal bulb and caused a volvulus of the body of the stomach causing partial obstruction which was corrected after pulling the gastrostomy tube back with external bumper at 3cm. The rest of the stomach and duodenum were unremarkable. The PEG tube was replaced and feeding was initiated after 24 hours. A PEG is a relatively safe procedure. However, the number of patients who are dependent upon gastrostomy tube feeding is increasing and therefore complications may become increasingly prevalent. Internal bumper migration is one such rare complication that can result in gastric outlet obstruction leading to imaging and procedures. Since most patients that have PEG tubes have an underlying motor or cognitive dysfunction they may not be able to provide a comprehensive history, further imaging and blood work is not avoidable in such patients. However simple re-adjustment of the gastrostomy tube can resolve the problem1901_A Figure 1. Gastric Volvulus around the migrated PEG tube1901_B Figure 2. PEG tube after being replaced.

Which G-Tube to Use in Pullers: Assessment of Pull Pressures on Skin Models to Determine Optimal Catheter Choice in Patients with Recurrent Pulled Gastrostomy Tubes.

Pulled or dislodged gastrostomy catheters represent a common complication associated with percutaneous gastrostomy and are a common cause of recurrent visits in patients with altered mental status.We intended to perform an experiment to compare the pull forces required to dislodge different commonly used gastrostomy catheters. We used a digital force gauge device to measure the pull forces required to dislodge three types of 20 French gastrostomy catheters in double-layer skin models. These included the Flow 20 Pull Method (Cook Medical, Bloomington, IN, USA), Entuit Gastrostomy BR Balloon Retention feeding tube (Cook Medical, Bloomington, IN, USA), and Ponsky Non-Balloon Replacement Gastrostomy Tube (CR Bard Inc, Salt Lake City, Utah, USA). The catheters were inserted into the skin model using the same technique as would be utilized in a patient. The mean forces measured to dislodge the per-oral Flow 20 Pull Method, Entuit Thrive Balloon Retention, and button-type retention Ponsky replacement catheters were 35.6, 22.8, and 20.6 Newtons, respectively. The pull method per-oral gastrostomy catheter required significantly more pull force to dislodge than both the Ponsky button-type retention catheter and the Entuit balloon retention catheters. There was no significant difference in the pull force required to dislodge the Ponsky replacement catheter and the Entuit balloon retention catheter. Per-oral image-guided gastrostomy with pull-method button-type retention catheters may be the ideal choice in patients at high risk of tube dislodgment.

Tarry Stool Occurred after Replacement of Percutaneous Endoscopic Gastrostomy Tube

Tarry Stool Occurred after Replacement of Percutaneous Endoscopic Gastrostomy Tube

Gastrostomy tube placement for long-term oral drug administration in non-human primates.

Non-human primates (NHPs) are often used as recipients in preclinical transplantation research that in most cases involves administration of various drugs including immunosuppressants. Long-term oral drug administration, particularly tacrolimus, is challenging in the transplant recipient NHPs. Oral drug administration method using the mixture of drug and fruit juice has been used in NHPs, but this is not always effective in all monkeys. To those monkeys who are poorly compliant, oral drug administration in restraint or administration using gastrostomy tube should be necessary. The aim of this study was to compare the efficacy of between oral drug administration in restraint and administration using gastrostomy tube and to report complications and solutions to overcome the problems related to gastrostomy tube for long-term oral drug dosing in rhesus monkeys. Fifteen of 4- to 5-year-old male and female healthy rhesus monkeys weighing 5.0-6.8kg were used as recipients for porcine pancreatic islet transplantation. Oral drug administration in restraint was used for four monkeys, and gastrostomy tube was placed to other 11 monkeys (8-French Feeding tube, n=6; Tri-Funnel Replacement Gastrostomy tube, n=5). Oral immunosuppressive drugs such as sirolimus and tacrolimus were administered through the tube. The efficacy and the extent of ease for administration and related complications were compared between two groups. The complication of gastrostomy included a transient inflammation in the skin and peritonitis caused by a leakage around implantation site (one case), which could be overcome by changing suture method and tube type to interlocking box suture and Tri-Funnel Replacement Gastrostomy tube, respectively. Despite these complications, oral drug administration using gastrostomy tube allowed us to perform accurate dosage of drug administration and to reduce the stress that both the monkey and the researcher may experience. Taken together, this study showed that gastrostomy tube placement is a better alternative to oral drug administration in restraint for long-term oral drug administration in rhesus monkeys who tend to refuse to eat the mixture of drug and fruit juice.

Cooperation between Single-Handed and Group Practices Ensures the Replacement of Gastrostomy Tubes and Tracheal Cannulas in Home Medical Care Settings.

In Japan, patients who require home medical care are increasing especially in the elderly. In home medical care settings, devices such as gastrostomy tubes, tracheal cannulas, and urethral catheters are usually replaced by visiting physicians or nurses. However, device replacement services are not always available in Japan. Unless device replacement services are sufficiently provided to patients at home, patients have to suffer various disadvantages, including a forced visit to a hospital for device replacement despite inability to walk. We therefore investigated background factors of clinics and nursing stations providing home-care visits using a cross-sectional postal survey from August to September 2013. We targeted physicians from 5,828 clinics providing home medical care and nurses from 1,798 home-visit nursing stations across six prefectures (Tokyo, Kanagawa, Saitama, Chiba, Miyagi and Iwate). Responses were received from 933 clinics (16.5%) and 552 stations (31.3%). We analyzed the responses using multivariable logistic regression with two models. "Model 1" mainly included the number of full-time staff and the availability of a 24-hour care service system, and "Model 2" mainly included the number of clinics, the number of home-visit nursing stations, and the ratio of the population aged ≥ 65 years to study the influence of medical resources. We thus found that clinic staff numbers and 24-hour care availability were associated with physicians' replacement of gastrostomy tubes and tracheal cannulas (p < 0.001 for each). In conclusion, single-handed and group practices need to cooperate to ensure the replacement of these devices in home medical care settings.

Predictive Factors Associated with Oral Intake Ability in Gastrostomy Patients Under Long-Term Care.

To determine the physical indicators associated with oral intake status and swallowing function in gastrostomy patients under long-term care. Cross-sectional study. Thirty-one hospitals that perform gastrostomy insertion, replacement and management. A total of 117 respondents from 31 hospitals in Japan underwent gastrostomy tube replacement and management between September 2012 and January 2014. Each participant underwent a gastrostomy at least 6 months prior to the study, and received long-term care either at home, a care facility, or a hospital. We conducted a questionnaire survey at Japanese hospitals and used the data obtained from 117 respondents for analysis. The survey was conducted using a questionnaire form that collected information about the following items: oral intake status, sex, age, disease history, number of days elapsed since gastrostomy, residence status, modified Rankin Scale score, consciousness, oral hygiene status, articulation and phonation, voluntary saliva swallow, Modified Water Swallow Test, and Food Test. Results revealed significant differences in modified Rankin Scale scores, sputum production, articulation and phonation, and voluntary saliva swallowing between patients who were orally fed and those who were not. Moreover, sputum production and voluntary saliva swallowing were strongly associated with oral intake status. Finally, sputum production, articulation and phonation, and voluntary saliva swallowing were strongly associated with swallowing function test results. Results from this study suggested that sputum production, articulation and phonation, and voluntary saliva swallowing could be used as indicators for estimating oral intake status and swallowing function in gastrostomy patients under long-term care.

Gastrostomy tube replacement by endoscopic cannulation of a narrowed previous tube site.

Percutaneous endoscopic gastrostomy is warranted when oral feeding is not feasible. Indications include central nervous system disorders, head trauma and occasionally malignancies of upper gastrointestinal tract. If tube replacement after accidental dislodgement is delayed, the track may become narrowed. This may compromise routine replacement and may require repeated procedures. Occasionally no further external dilation is possible. We describe the endoscopic cannulation of the previously used track after its internal cannulation and subsequent external dilation and the successful replacement of a gastrostomy tube.