Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG)

Abstract

Background and study aims: Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia may result in prolonged hospitalization and postoperative mortality. This study evaluated the efficacy of using semi-solid feeds to reduce feeding-related adverse events and improve clinical outcomes. Patients and methods: Patients who received PEG for enteral nutrition at our hospital between January 2014 and December 2015 were allocated to a postoperative feeding protocol that used either liquid feed or semi-solid feed. Baseline characteristics, postoperative feeding-related adverse events and clinical outcomes in the 2 groups were prospectively analysed and compared. Results: One hundred and seventeen PEG patients (age range: 59 – 97 years, male: 53) were enrolled with 72 patients given liquid feed and 45 patients receiving semi-solid feed. Baseline characteristics were similar in both groups. The semi-solid feed group experienced fewer incidence of feeding-related aspiration pneumonia (2.2 % vs. 22.2 %, P < 0.005) and shorter postoperative hospital length of stay (12.7 days vs. 18.8 days, P < 0.01). Significant differences were not observed in the frequency of peristomal infection (11.1 % vs. 12.5 %, P = 0.82), feeding-related diarrhea (2.2 % vs. 12.5 %, P = 0.09) and 30-day mortality rates (2.2 % vs. 8.3 %, P = 0.25). Conclusions: Semi-solid feeding may reduce the risk of aspiration pneumonia and shorten postoperative hospital length of stay after PEG. Semi-solid feeds are safe to use and can be employed either as a first line feeding protocol or an alternative when liquid feeding is unsuccessful.

Percutaneous Endoscopic Gastrostomy in a Patient With Continuous Intrathecal Baclofen Infusion Therapy

“…Nevertheless, this technique is not widely used because the size of the PEG catheter employed is often small. Recently, large-caliber tubes using this technique, such as in our case, can also be safely inserted without increasing the risk of peristomal infection [12]. In our patient, the introducer technique was used along with systemic antimicrobial prophylaxis.…”

Effects of Semi-Solid Enteral Formula on Aspiration Pneumonia and Diarrhea

“…Thickened enteral formula is a formula in which viscosity is intentionally increased to prevent enteral nutrition-related complications, such as aspiration pneumonia and diarrhea [12] and has been used mainly in Japan [11]. It has been more than a decade since semi-solid enteral formula was developed but there is limited published literature on this topic despite the wide usage of semi-solid enteral formula in Japan [13]. Semi-solid enteral formula is considered to be more physiologic because swallowed food does not enter the stomach in the liquid form [13].…”

“…It has been more than a decade since semi-solid enteral formula was developed but there is limited published literature on this topic despite the wide usage of semi-solid enteral formula in Japan [13]. Semi-solid enteral formula is considered to be more physiologic because swallowed food does not enter the stomach in the liquid form [13].…”

A novel semi‐solidifying liquid formula via the nasogastric route to maintain enteral nutrition in the event of recurrent aspiration pneumonia: A case report

“…In Japan, semi‐solid feeds are often used to deal with feeding‐related adverse events such as aspiration pneumonia, peristomal leakage, and diarrhea in PEG patients. Due to its high viscosity, semi‐solid feed has been reported to reduce the incidence of gastroesophageal reflux and a recent study also showed that it can reduce the risk of aspiration pneumonia in PEG patients …”

“…Semi‐solid feeds have been demonstrated to reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG) . However, the use of semi‐solid feeds via the nasogastric route is difficult in practice due to the high viscosity and only one case report exists in the literature .…”