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Gastrostomy tube feeding in adults: the risks, benefits and alternatives

  • Sue Cullen (a1)

Abstract

Enteral feeding (or ‘tube feeding’) is a very common inpatient intervention to maintain nutritional status where the oral route is inadequate, unsafe or inaccessible. A proportion of patients will need to continue tube feeding in the community after their admission and will require a gastrostomy tube. Although gastrostomy insertion is relatively straightforward, it is not without complications in an often frail and vulnerable group of patients and a multidisciplinary approach is necessary to ensure that the procedure is appropriate. Some patients are better managed with careful assisted hand feeding or nasogastric tubes. Particular care needs to be taken in deciding whether patients with dementia should have a gastrostomy in view of data suggesting that this group of patients have a particularly poor prognosis after the procedure. Decisions regarding the provision of enteral nutrition at the end of life or where patients are not competent to make an informed judgement are particularly challenging and need to be made on a case-by-case basis.

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Copyright

Corresponding author

Corresponding author: Dr Sue Cullen, fax +01494425597, email sue.cullen@buckshealthcare.nhs.uk

References

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1.Artificial Nutrition Support in the UK (2010) British Artificial Nutrition Survey (BANS). Published on website byBAPEN. ISBN: 978-1-899467-61-7.
2.Thomas, S, Cantrill, S, Waghorn, DJ et al. . (2007) The role of screening and antibiotic prophylaxis in the prevention of percutaneous gastrostomy site infection caused by methicillin-resistant Staphylococcus aureus. Aliment Pharmacol Ther 25, 593597.
3.Mathus-Vliegen, LM & Koning, H (1999) Percutaneous endoscopic gastrostomy and gastrojejunostomy: A critical reappraisal of patient selection, tube function and the feasibility of nutritional support during extended follow-up. Gastrointest Endosc 50, 746754.
4.Grant, JP (1993) Percutaneous endoscopic gastrostomy. Initial placement by single endoscopic technique and long-term follow-up. Ann Surg 217, 168174.
5.Hull, MA, Rawlings, J, Murray, FE et al. . (1993) Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet 341, 869872.
6.Abuksis, G, Mor, M, Segal, N et al. . (2000) Percutaneous endoscopic gastrostomy: High mortality rates in hospitalized patients. Am J Gastroenterol 95, 128132.
7.Rabeneck, L, Wray, NP & Petersen, NJ (1996) Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes. J Gen Intern Med 11, 287293.
8.Sanders, DS, Carter, MJ, D'Silva, J et al. . (2000) Survival analysis in percutaneous endoscopic gastrostomy feeding: A worse outcome in patients with dementia. Am J Gastroenterol 95, 14721475.
9.Zopf, Y, Maiss, J, Konturek, P et al. . (2011) Predictive factors of mortality after PEG insertion: Guidance for clinical practice. JPEN J Parenter Enteral Nutr 35, 5055.
10.Janes, SE, Price, CS & Khan, S (2005) Percutaneous endoscopic gastrostomy: 30-day mortality trends and risk factors. J Postgrad Med 51, 2329.
11.Scoping our practice (2004) Report of National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Published on website byNational Confidential Enquiry into Patient Outcome and Death. Available at: http://www.ncepod.org.uk/2004report/
12.Office of Public Sector information. Mental Capacity Act 2005. http://www.opsi.gov.uk/acts/acts2005/ukpga_20050009_en_1 (accessed 31 August 2009).
13.Royal College of Physicians (2010) Oral Feeding Difficulties and Dilemmas. A Guide to Practical Care, Particularly towards the End of Life. London: Royal College of Physicians. ISBN: 9781860163715.
14.Cervo, FA, Bryan, L & Farber, S (2006) To PEG or not to PEG: A review of the evidence for placing feeding tubes in advanced dementia and the decision-making process. Geriatrics 61, 3035.
15.Chernoff, R (2006) Tube feeding patients with dementia. Nutr Clin Pract 21, 142146.
16.Sanders, DS, Anderson, AJ & Bardhan, KD (2004) Percutaneous endoscopic gastrostomy: An effective strategy for gastrostomy feeding in patients with dementia. Clin Med 4, 235241.
17.Finucane, TE, Christmas, C & Travis, K (1999) Tube feeding in patients with advanced dementia: A review of the evidence. JAMA 282, 13651370.
18.Anderson, MR, O'Connor, M, Mayer, P et al. . (2004) The nasal loop provides an alternative to percutaneous endoscopic gastrostomy in high-risk dysphagic stroke patients. Clin Nutr 23, 501506.

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