Jiro Kanie

Prevention of gastroesophageal reflux using an application of half-solid nutrients in patients with percutaneous endoscopic gastrostomy feeding

To the Editor: Although percutaneous endoscopic gastrostomy (PEG) feeding is widely used as a convenient method of long-term nutritional support, administration of liquid nutrients often accompanies complications such as vomiting or diarrhea. Gastroesophageal reflux (GER) presumably causes vomiting, which may result in aspiration. Therefore, half-solid nutrients were used for PEG feeding, and whether this approach can reduce GER was examined. Seventeen patients (mean age standard deviation5 79.9 10.5) who were on PEG feeding participated in this study. Written informed consent was obtained from all patients. Liquid or half-solid nutrients were administered via PEG tubing in a randomized order. Half-solid nutrients were prepared by mixing 5 g of agarose with 500 mL of liquid nutrients diluted with the same volume of water. Incidence of GER was assessed using computed tomography (CT) scan of the esophagus. Liquid nutrients were administered over 15 minutes in portions of 400 mL containing 20 mL of the water-soluble contrast material, Gastrografin (methylglucamine diatrizoate). The halfsolid nutrients were administered via bolus injections of the same volume of nutrients, which were contained separately in 50 mL syringes. Thirty minutes after the administration, a CT scan was performed in 1-cm-thick slices of the esophageal portion. GER was confirmed if the Hounsfield number exceeded 100 in each slice examined. A Hounsfield number of 100 was employed because it can unequivocally distinguish the mixture of the nutrients containing contrast material from the esophageal and other surrounding tissues. A radiologist who was not informed of the type of nutrients used assessed the CT images. Statistical comparison of the incidence of GER between the two types of nutrients was made using McNemar test. GER was confirmed in 10 of the 17 subjects (58.8%) when they received liquid nutrients. By contrast, when they received half-solid nutrients, only four of 17 subjects (23.5%) showed evidence of GER from CT findings (w56.0, df51, P5.014, by McNemar test) (Table 1). The advantages of PEG feeding over nasogastric feeding have been discussed elsewhere, although there have been some complications reported. Of the complications, vomiting can be a cause of fatal aspiration due to a reflux of the administered nutrients. The tubing used for PEG feeding has made it possible to apply half-solidified nutrients, which we hypothesized would cause less reflux from the stomach. As expected, less evidence of GER was observed when using half-solid nutrients than when using

Prevention of Late Complications by Half-Solid Enteral Nutrients in Percutaneous Endoscopic Gastrostomy Tube Feeding

Background: Percutaneous endoscopic gastrostomy feeding is accompanied by unique complications, which are not easily controlled. Objective: In an attempt to decrease complications, we used half-solid nutrients for percutaneous endoscopic gastrostomy feeding in an 85-year-old woman. The patient had been receiving enteral nutrients via percutaneous endoscopic gastrostomy, and we examined whether this approach can reduce complications. She presented with regurgitation of enteral nutrients and recurrent respiratory infections. Methods: Half-solid enteral nutrients, prepared by mixing liquid enteral nutrients with agar powder, were administered via percutaneous endoscopic gastrostomy. Results: Symptoms of gastroesophageal reflux disappeared immediately after the start of half-solid enteral nutrient feeding. Conclusion: Gastroesophageal reflux and leakage, two intractable late complications of percutaneous endoscopic gastrostomy tube feeding, can be alleviated by the solidification of enteral nutrients. Since this method allows quick administration of nutrients, it is also expected to help prevent the occurrence of decubitus ulcers and reduce the burden to the caregiver.

Complications Following Percutaneous Endoscopic Gastrostomy: Acute Respiratory Infection and Local Skin Infection

Abstract: Few studies of percutaneous endoscopic gastrostomy (PEG) have evaluated the effects of antibiotic prophylaxis, PEG placement technique and early PEG feeding on acute postoperative complications. In this retrospective study, we investigated associations between postoperative management of PEG and complications of infection. The medical records of 271 patients were included in this study. Administration of antibiotics, early and delayed enteral feeding, and PEG placement technique were analyzed as risk factors for infectious complications. The rate of local skin infection correlated with early PEG feeding, but there was no difference in the rate of local skin infection due to postoperative administration of antibiotics. Early feeding with the usual enteral formula was a strong risk factor for local skin infection. The rate of local skin infection was higher in the “Push/Pull” technique than the “Introducer” technique. As for aspiration, the rate of complication was lower in groups with postoperative administration of antibiotics than in groups without administration of antibiotics, but there was no association between aspiration and early feeding or PEG placement technique. Local skin infection correlated with early postoperative feeding and was not correlated with antibiotic prophylaxis. However, the administration of antibiotics is recommended for the prevention of aspiration.