Enteral Nutrition via Percutaneous Endoscopic Gastrostomy
Enteral Nutrition via Percutaneous Endoscopic Gastrostomy
Background: Since it was described in 1980, percutaneous endoscopic gastrostomy (PEG) has been a widely used method for insertion of a gastrostomy tube in patients who are unable to swallow or maintain adequate nutrition. The aim of the present paper was to determine the complications of PEG insertion and to study pre- and post-procedural nutritional status.
Methods: During the period of March 1999September 2004, placement of PEG tube was performed in 85 patients (22 women and 63 men). Patient nutritional status was assessed before and after PEG insertion via anthropometric measurements.
Results: The most frequent indication for PEG insertion was neurological disorders (65.9%). Thirty patients died due to primary disease and two patients due to PEG-related complications within 5 years. There were 14 early complications in 10 patients (15.2%; < 30 days), and 18 late complications in 12 patients (19.6%). Total mortality was 37.6%. All complications other than four were minor. Before PEG insertion, patients were assessed with subjective global assessment and it was determined that 43.2% of them had severe, and 41.9% of them had mild malnutrition. After PEG insertion, significant improvements on patient nutrition levels was observed.
Conclusion: Percutaneous endoscopic gastrostomy is a minimally invasive gastrostomy method with low morbidity and mortality rates, is easy to follow up and easy to replace when clogged.
Adequate enteral nutrition is a major medical goal in patients with insufficient oral food intake caused by various underlying diseases of benign and malignant origin. Patients who need enteral feeding generally have severe malnutrition.
Enteral feeding is a more practical and easier method in patients who have a functionally intact gastrointestinal tract but who are unable to feed orally, compared with parenteral feeding. In addition to nutritional support, enteral feeding increases local intestinal defense, and provides structural and functional gastrointestinal integrity. It is also safe, economical, and is tolerable by patients.
The most appropriate method for long-term enteral feeding is gastrostomy or, occasionally, jejunostomy. There are three ways to create a gastrostomy: surgically, radiologically or endoscopically.
Surgical gastrostomy is technically simple but involves an abdominal incision under general anesthesia. Because most patients are malnourished, often with multiple medical problems, the operative risk and rate of mortality is high.
Percutaneous endoscopic gastrostomy (PEG) is preferred for patients who have normal intestinal functions but who are malnourished because of disorders such as stroke, dementia, malignancy and/or swallowing or aspiration problems.
Since its first description in 1980 by Gauderer et al. , the percutaneous endoscopic technique for placing a feeding gastrostomy tube has rapidly gained worldwide acceptance because of its ease and safety. The superiority of PEG over nasogastric tube feeding has been demonstrated in various studies in which long-term enteral nutrition via PEG proved to have less frequent episodes of reflux and aspiration, achieved a better nutritional result, was better tolerated, and was cosmetically more acceptable.
The aim of the present study was to observe patients with PEG for short- and long-term complications and to investigate the effectiveness of enteral feeding in these patients.
Background: Since it was described in 1980, percutaneous endoscopic gastrostomy (PEG) has been a widely used method for insertion of a gastrostomy tube in patients who are unable to swallow or maintain adequate nutrition. The aim of the present paper was to determine the complications of PEG insertion and to study pre- and post-procedural nutritional status.
Methods: During the period of March 1999September 2004, placement of PEG tube was performed in 85 patients (22 women and 63 men). Patient nutritional status was assessed before and after PEG insertion via anthropometric measurements.
Results: The most frequent indication for PEG insertion was neurological disorders (65.9%). Thirty patients died due to primary disease and two patients due to PEG-related complications within 5 years. There were 14 early complications in 10 patients (15.2%; < 30 days), and 18 late complications in 12 patients (19.6%). Total mortality was 37.6%. All complications other than four were minor. Before PEG insertion, patients were assessed with subjective global assessment and it was determined that 43.2% of them had severe, and 41.9% of them had mild malnutrition. After PEG insertion, significant improvements on patient nutrition levels was observed.
Conclusion: Percutaneous endoscopic gastrostomy is a minimally invasive gastrostomy method with low morbidity and mortality rates, is easy to follow up and easy to replace when clogged.
Adequate enteral nutrition is a major medical goal in patients with insufficient oral food intake caused by various underlying diseases of benign and malignant origin. Patients who need enteral feeding generally have severe malnutrition.
Enteral feeding is a more practical and easier method in patients who have a functionally intact gastrointestinal tract but who are unable to feed orally, compared with parenteral feeding. In addition to nutritional support, enteral feeding increases local intestinal defense, and provides structural and functional gastrointestinal integrity. It is also safe, economical, and is tolerable by patients.
The most appropriate method for long-term enteral feeding is gastrostomy or, occasionally, jejunostomy. There are three ways to create a gastrostomy: surgically, radiologically or endoscopically.
Surgical gastrostomy is technically simple but involves an abdominal incision under general anesthesia. Because most patients are malnourished, often with multiple medical problems, the operative risk and rate of mortality is high.
Percutaneous endoscopic gastrostomy (PEG) is preferred for patients who have normal intestinal functions but who are malnourished because of disorders such as stroke, dementia, malignancy and/or swallowing or aspiration problems.
Since its first description in 1980 by Gauderer et al. , the percutaneous endoscopic technique for placing a feeding gastrostomy tube has rapidly gained worldwide acceptance because of its ease and safety. The superiority of PEG over nasogastric tube feeding has been demonstrated in various studies in which long-term enteral nutrition via PEG proved to have less frequent episodes of reflux and aspiration, achieved a better nutritional result, was better tolerated, and was cosmetically more acceptable.
The aim of the present study was to observe patients with PEG for short- and long-term complications and to investigate the effectiveness of enteral feeding in these patients.
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