The role of endoscopy in enteral feeding

Jain, Rajeev Ratan; Maple, John T.; Anderson, Michelle A.; Appalaneni, Vasundhara; Ben–Menachem, Tamir; Decker, G. Anton; Fanelli, Robert D.; Fisher, Laurel; Fukami, Norio; Ikenberry, Steven O.; Jue, Terry L.; Khan, Khalid; Krinsky, Mary Lee; Malpas, Phyllis M.; Sharaf, Ravi; Dominitz, Jason A.

doi:10.1016/j.gie.2010.10.021

Cited by 72 publications

(42 citation statements)

References 72 publications

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“…The reason for the lower 30-day mortality rate in the PEG group could be due to the following: first, administration of prophylactic antibiotics is recommended in PEG and is not generally recommended in RIG,45 which may have resulted in a reduction in the rates of peristomal infection and other acute infectious complications in PEG;893133 second, the tubes used in the two methods differ in shape, as the RIG tubes are relatively thinner in diameter (10-14 F) than the PEG tubes (20 F), and clogging of the feeding tube or tube blockage would be more frequent in tubes of smaller diameters; 1 furthermore, as RIG tubes are fixed with a balloonretention system, they are not as securely fixed as PEG tubes, and peristomal leakage or tube displacement would be more frequent 2833. These differences in tubes may have induced a significant increase in the rate of tube related complications 9.…”

Section: Discussionmentioning

confidence: 99%

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

et al. 2016

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Background/AimsA percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG.MethodsMajor electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0.ResultsFifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted.ConclusionsThe present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy.

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Section: Discussionmentioning

confidence: 99%

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

et al. 2016

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“…The most common indications include inadequate swallowing as a result of a neurological event, oropharyngeal or esophageal cancer, and severe facial trauma [41,42] . Based on data from 1327 patients, Kurien et al [43] demonstrated in a recently-published trial that patients who underwent gastrostomy had significantly lower mortality compared to those who deferred the procedure.…”

Section: Percutaneous Endoscopic Gastrostomymentioning

confidence: 99%

Gastroenteric tube feeding: Techniques, problems and solutions

Blumenstein

Shastri

Stein

2014

WJG

351

288

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Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.

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“…It has been emphasized that short-term, less invasive methods like nasogastric (NG) feeding may be preferable in cases where the patient is unlikely to survive for 30 days after PEG placement [6]. Therefore, in this study, we aimed to identify biomarkers that may guide the decision of whether to perform the elective procedure of PEG.…”

Section: Introductionmentioning

confidence: 99%

High C-Reactive Protein and Low Albumin Levels Predict High 30-Day Mortality in Patients Undergoing Percutaneous Endoscopic Gastrotomy

et al. 2017

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BackgroundPercutaneous endoscopic gastrotomy (PEG) enables long-term enteral feeding. The aim of this study was to identify biomarkers that may guide the decision of whether to perform the elective procedure of PEG.MethodsThe medical records of all patients who underwent PEG in our hospital from 2010 to 2016 were screened retrospectively. Patients with mortality within a 30-day follow-up period and those without were compared using the Chi-square test, and continuous variables were compared with the Kruskal-Wallis and Mann-Whitney U tests. Receiver operating characteristic (ROC) curve analysis was used to demonstrate the ability of biomarkers to predict mortality; a cut-off point was determined and its sensitivity, specificity, and positive and negative predictive values were calculated. The Youden index was used to determine the cut-off point. Kaplan-Meier analysis was used to identify PEG-related mortality risk factors and a Cox regression model was applied for risk characterization.ResultsA total of 120 patients who underwent PEG were evaluated in the study. The mean age was 67.00 ± 18.00 years. The most common indication for PEG was cerebrovascular disease, in 69 (57.5%) of the patients. Infection of the PEG site was most common within 14 days after PEG tube placement, occurring in 13 patients (10.3%). The mortality rate among patients with post-PEG infection was 68.2%, significantly higher than in patients without infection (P = 0.012). Thirty-four patients (28.3%) died within 30 days of undergoing PEG. CRP values ≥ 78.31 mg/L increased mortality by 8.756-fold, and albumin levels < 2.71 g/dL increased mortality by 2.255-fold.ConclusionOur results indicate that the presence of both high CRP level and low albumin level were associated with significantly higher rate of mortality (73.1%) in patients who underwent PEG.

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The role of endoscopy in enteral feeding

Cited by 72 publications

References 72 publications

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

Gastroenteric tube feeding: Techniques, problems and solutions

High C-Reactive Protein and Low Albumin Levels Predict High 30-Day Mortality in Patients Undergoing Percutaneous Endoscopic Gastrotomy

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