Differences in the incidence of postoperative pneumonia after percutaneous endoscopic gastrostomy between liquid and semi-solid nutrient administration

Abstract

Background/ObjectivesThis historical control study examined the differences in the incidence of postoperative pneumonia between patients administered liquid and semi-solid nutrients after percutaneous endoscopic gastrostomy (PEG).Subjects/MethodsThe medical records of adult patients who underwent PEG between March 1999 and March 2014 were investigated. The patients were administered either liquid or semi-solid nutrient and examined for gastroesophageal reflux via radiography after PEG. The study period was divided into periods I (liquid nutrient to all patients), II (semi-solid nutrient to patients with reflux and liquid nutrient to those without), and III (semi-solid nutrient to all patients). The patient characteristics and incidence of postoperative pneumonia were stratified by the periods. To assess the relationship between postoperative pneumonia and the periods, a logistic regression analysis was performed.ResultsOf 370 patients enrolled, 149 were in period I, 64 in period II, and 157 in period III. Postoperative pneumonia was more frequently observed in period I (20.8%) than in periods II (7.8%) and III (10.2%). The odds ratios were higher in period I (period I vs. II: 3.10 [95% confidence intervals: 1.15–8.38]; period I vs. III: 2.32 [1.21–4.44]). The incidence of gastroesophageal reflux did not greatly differ between periods II (25.0%) and III (35.0%).ConclusionsThe incidence of postoperative pneumonia after PEG was lower in the patients administered semi-solid nutrient than in those administered liquid nutrient, suggesting that semi-solid nutrient administration to patients with PEG tubes is preferable to prevent postoperative pneumonia. Furthermore, it may be favored especially in those with gastroesophageal reflux.

Semisolid vs Liquid Nutrients and 30‐Day Readmission in Gastrostomy Tube–Fed Patients: A Propensity‐Matched Analysis

“…Moreover, previous studies used a variety of semisolid nutrient preparations, with viscosities ranging from 1000 to 20,000 mPas. [8][9][10]15,19,20 To date, neither viscosity of semisolid nutrient preparations nor methods for measuring that viscosity have been defined. 6,7 Therefore, differences in physical characteristics of different types of semisolid nutrient preparations may have resulted in inconsistency in study results.…”

“…A previous study showed that a smaller proportion of patients receiving semisolid nutrients than of those receiving liquid nutrients required readmission within 30 days after discharge 9 . However, no differences between semisolid and liquid nutrients in length of stay in intensive care units (ICUs) 12‐14 or short‐term mortality 9,12,15 have been reported. Additionally, studies have shown conflicting findings on the ability of semisolid nutrients to reduce vomiting, 8,12,14 pneumonia or lung infection, 8,9,12‐15 high blood glucose, 12,16 gastroesophageal reflux, 10,17‐19 diarrhea, 5,8‐10,14,20 fever, 8,20 length of hospital stay, 9,12,14 and peristomal infection 9,15 .…”

A case of tracheal obstruction caused by reflux and aspiration of semi-solid nutrients via the nasogastric tube

“…Benefits of semi-solid nutrients such as reduced diarrhea, gastroesophageal reflux, and aspiration pneumonia were reported in some articles [[1], [2], [3]]. Most published articles focused on semi-solid nutrients through PEG.…”

“…They are useful for patients with diarrhea or reflux from enteral feeding. There are some reports insisting the safety and benefits of semi-solid nutrients such as reduced diarrhea, shorter administration time, and lower frequency of aspiration pneumonia [[1], [2], [3]]. Semi-solid nutrients are usually given through percutaneous endoscopic gastrostomy (PEG), but it is unsuitable for nasogastric tube administration due to its high viscosity.…”

Risk Factors for Gastrointestinal Symptoms post Enteral Nutrition Initiation via a Gastrostomy Tube

“…6 Semi-solid medical foods may reduce the risk of aspiration pneumonia in gastrostomy-fed patients. 12,13 My department will be conducting further investigation involving more patients receiving semisolid medical foods.…”