Asuncion Ballarin

Enteral access in adults.

Enteral feeding is widely used for hospitalized patients but is also used for ambulatory persons living at home or in home care settings. Aside from decisions that must be made about appropriate nutrient delivery, choices related to which type of enteral access will be used and the procedures for enteral access surveillance are extremely important. In this paper we review the various techniques for establishment of enteral access in adult patients. Prevention and treatment of potential complications are detailed. The use of protocols that are written by a multidisciplinary nutrition team is mandatory. It is also of vital importance to discuss treatment plans with the patient and care givers, to assure appropriate follow-up, and to consider ethical issues related to enteral feeding.

Percutaneous endoscopic jejunostomy in patients with gastroparesis following lung transplantation: feasibility and clinical outcome.

The aim of the present study was to describe success rates, complications, and outcome in patients who underwent percutaneous endoscopic jejunostomy (PEJ) because of gastroparesis due to previous lung transplantation. Between October 2008 and May 2011, 14 attempts at PEJ placement were made in 12 patients in our center. Of the 14 attempts, 11 were successful, giving a technical success rate of 78.6 %. Median duration of followup was8.5 months (2–15 months). No immediate complications were reported. Two severe complications occurred during follow up (one volvulus and one jejunocolic fistula). Jejunal nutrition was well tolerated in most of patients (9 /10). PEJ insertion is a feasible technique, which could help to provide nutritional support for patients with gastroparesis and previous lung transplantation.

The use of enteral access for continuous delivery of levodopa-carbidopa in patients with advanced Parkinson’s disease

Background Continuous delivery to the jejunum of levodopa-carbidopa is a promising therapy in patients with advanced Parkinson’s disease, as it reduces motor fluctuation. Percutaneous endoscopic gastrostomy and jejunal tube (PEG-J) placement is a suitable option for this. However, studies focused in PEG-J management are lacking. Objectives We report our experience regarding this technique, including technical success, adverse events and outcomes, in patients with advanced Parkinson’s disease. Methods Twenty-seven advanced Parkinson’s disease patients (17 men, median age: 64 years, median disease duration: 11 years) were included in a retrospective study from June 2007 to April 2015. The median follow-up period was 48 months (1–96). Results No adverse events were noted during and after nasojejunal tube insertion (to assess treatment efficacy). After a good therapeutic response, a PEG-J was placed successfully in all patients. The PEG tube was inserted according to Ponsky’s method. The jejunal extension was inserted during the same procedure in all patients. Twelve patients (44%) experienced severe adverse events related to the PEG-J insertion, which occurred after a median follow-up of 15.5 months. Endoscopy was the main treatment modality. Patients who experienced severe adverse events had a higher comorbidity score (p = 0.011) but were not older (p = 0.941) than patients who did not. Conclusions While all patients responded well to levodopa-carbidopa regarding neurological outcomes, gastro-intestinal severe adverse events were frequent and related to comorbidities. Endoscopic treatment is the cornerstone for management of PEG-J related events. In conclusion, clinicians and endoscopists, as well as patients, should be fully informed of procedure-related adverse events and patients should be followed in centres experienced in their management.

Aspects spécifiques de la nutrition artificielle à domicile

Le but premier ďune nutrition artificielle a domicile est de poursuivre ľadministration ďun apport nutritionnel adequat tout en permettant au patient de quitter ľhopital et, dans la mesure du possible, de retrouver une activite familiale, sociale et professionnelle normale.

P056 Nutrition parentérale à domicile (NPAD) : une expérience de 20 ans dans un centre belge de référence

Introduction et but de l’etude La NPAD qui fut initialement utilisee chez des patients presentant une insuffisance intestinale chronique associee a une pathologie benigne (B) a ete progressivement etendue aux patients souffrant d’un cancer a un stade avance (C) et incapables d’etre alimentes par voie orale. Nous rapportons l’experience de 20 ans de NPAD representant plus de 90 000 jours de traitement. Materiel et methodes Les dossiers de tous les patients sous NPAD entre 1987 et 2007 ont ete revus retrospectivement en soulignant l’incidence, la prevalence, maladies sous-jacentes, indications, evolution et complications septiques et hepatiques. Resultats En 20 ans, 125 patients ont ete inclus en NPAD, 65 (B) et 60 (C). L’incidence et la prevalence annuelles etaient respectivement de 3 et 3 en 1987, 15 et 32 en 2007. Les pathologies (B) etaient : maladie de Crohn (24 %), vascu-laire mesenterique (32 %), post-chirurgicale (16 %), enterite radi-que (4 %) et diverses (25 %). L’indication etait un grele court dans 85 %. La duree moyenne de NPAD etait de 52 mois. Parmi ces 65 patients (B) 26 sont decedes, 23 ont ete sevres et 16 sont en cours. Le deces fut lie a la NPAD dans 3/26 patients (13 %). On a observe 2 suicides. Seulement 2 patients sont candidats potentiels a une transplantation intestinale. Une alteration des enzymes hepatiques est frequente (65 %) mais 1 seul cas de faillite hepatique a ete observe. Un episode septique du catheter central survient tous les 23 mois en moyenne. Pour les patients (C) L’indication etait l’obstruction sur carcinose peritoneale (100 %). La survie mediane est de 63 jours (12-240 jours) pour C gastrique mais 35 jours (4-424 jours) pour les autres cancers. 19 des 60 (C) sont decedes endeans le 1 er mois et 5 ont survecu plus d’un an. Conclusions Le nombre de cas continue a augmenter. 35 % des patients (B) ont pu etre sevres. Le deces est attribuable a la NPAD dans 13 % des cas. Peu de cas sont candidats a une transplantation intestinale. La survie mediane des patients cancereux sous NPAD est tres courte.