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Reddick CA, Greaves JR, Flaherty JE, Callihan LE, Larimer CH, Allen SA. Choosing wisely: Enteral feeding tube selection, placement, and considerations before and beyond the procedure room. Nutr Clin Pract 2023; 38:216-239. [PMID: 36917007 DOI: 10.1002/ncp.10959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 03/16/2023] Open
Abstract
When an enteral feeding tube (EFT) is placed, it is not always known how long this nutrition support intervention will be needed. As a result, the type of device the patient originally has placed may not match the function it is required to serve or the lifestyle needs of the patient throughout their enteral nutrition journey. Medicare considers an EFT a prosthetic device, as it is replacing a permanently inoperable or nonfunctioning organ. If we think about an EFT the same way we think about a prosthetic limb, one that needs to be customized to meet all of the patient's functional and lifestyle needs, we can also begin to think beyond the procedure room and carefully consider a variety of factors that impact the patient at home receiving enteral nutrition. Proper fit, function, and style is essential in order for the patient to have a positive relationship with their EFT, contributing to their successful home enteral nutrition experience. Clinicians who care for these patients in any setting and in any capacity would benefit from enhancing their understanding of available EFT options, their design components, and available methods of placement. Many home care and outpatient clinicians adopt the role of patient advocate as it relates to a patient's enteral nutrition journey, and this expanded knowledge could be used to benefit the patient by improving their overall enteral nutrition experience and ultimately their relationship with their "prosthetic."
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Affiliation(s)
| | - June R Greaves
- Enteral Division, Coram/CVS Specialty Infusion Services, Illinois, Northbrook, USA
| | - Janelle E Flaherty
- Enteral Division, Coram/CVS Specialty Infusion Services, Illinois, Northbrook, USA
| | - Lindsey E Callihan
- Enteral Division, Coram/CVS Specialty Infusion Services, Illinois, Northbrook, USA
| | - Cara H Larimer
- Enteral Division, Moog Medical, Utah, Salt Lake City, USA
| | - Sarah A Allen
- Enteral Division, Coram/CVS Specialty Infusion Services, Illinois, Northbrook, USA
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Kim JM, Park JH, Kim HS, Lee JW, Lim HS, Choi WA, Kang SW. Epidemiology and diagnostic process of amyotrophic lateral sclerosis as distinct from myelopathy: 5-year cohort study of whole-population in South Korea. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:547-554. [PMID: 30421999 DOI: 10.1080/21678421.2018.1491600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the incidence, prevalence, and demographic factors of all amyotrophic lateral sclerosis (ALS) patients diagnosed in South Korea from 2011 to 2015, and to analyze cases misdiagnosed as myelopathy. METHODS The whole population registered under the Korean National Health Insurance Service (KNHIS) was applied. All 4551 patients who were registered as having ALS code from 2011 to 2015 were included. For all ALS patients, the incidence, prevalence, and demographic factors were assessed. Trends of diagnosis for myelopathy, and surgery prior to confirmation of ALS diagnosis were identified. RESULTS When the whole 48,135,715 KNHIS population enrolled in 2015, the incidence of ALS in 2015 was estimated to be 1.68 per 100,000 person-years, and the prevalence was 6.49 per 100,000 persons. Life expectancy of ALS can be calculated as 3.9 years after the diagnosis, and the mean age of diagnosis was 59.5 ± 13.1. A total of 1902 patients diagnosed with myelopathy before a diagnosis of ALS accounted for 0.13% of all myelopathy patients, and 41.8% of all ALS patients. It took an average of 471.7 d to confirm a diagnosis of ALS after the myelopathy diagnosis. Among the patients finally diagnosed with ALS, more patients underwent surgery for myelopathy (n = 263, 13.8%) than among patients who were diagnosed with myelopathy alone, and underwent surgery (n = 141,148, 9.8%). CONCLUSIONS This whole-population nationwide demographic study confirmed the data from previous studies. Clinicians should consider the possibility of ALS when making a myelopathy diagnosis, especially if the symptoms are sufficiently severe to require surgery.
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Affiliation(s)
- Jong Moon Kim
- a Department of Rehabilitation Medicine , CHA Bundang Medical Center, CHA University , Gyeonggi-do , Republic of Korea
| | - Jung Hyun Park
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
| | - Hyung Seop Kim
- c Departments of Physical Medicine and Rehabilitation , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea and
| | - Jang Woo Lee
- c Departments of Physical Medicine and Rehabilitation , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea and
| | - Hyun Sun Lim
- d Research and Analysis Team , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea
| | - Won Ah Choi
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
| | - Seong-Woong Kang
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
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Sato Y, Goshi S, Kawauchi Y, Nishigaki Y, Mizuno KI, Hashimoto S, Takeuchi M, Kobayashi M, Ozawa T, Nishizawa M, Aoyagi Y. Safety of unsedated PEG placement using transoral ultrathin endoscopy in patients with amyotrophic lateral sclerosis. Nutr Neurosci 2016; 20:71-75. [PMID: 25290682 DOI: 10.1179/1476830514y.0000000161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS In patients with amyotrophic lateral sclerosis (ALS), percutaneous endoscopic gastrostomy (PEG) placement under sedation often causes apnea or hypoventilation. The aim of the present study was to assess whether unsedated PEG placement in ALS patients using ultrathin endoscopy (UTE) via the transoral route can improve safety. METHODS Between 2003 and 2013, PEG placement was identified and reviewed in 45 patients with ALS. PEG was performed in 14 patients using transoral UTE without sedation (UTE group), 17 patients using conventional normal-diameter esophagogastroduodenoscopy (C-EGD) without sedation (unsedated C-EGD group) and 14 patients using C-EGD with sedation (sedated C-EGD group). We compared the clinical features, cardiopulmonary data before and during PEG placement, and complications related to PEG placement among the three groups. RESULTS There were no significant differences in age, male/female ratio, forced vital capacity, blood pressure, oxygen saturation before and during PEG, or major complications among the three groups. No minor complications were observed in the UTE group, whereas apnea and/or hypoventilation were observed in the sedated C-EGD group and aspiration pneumonia was observed in the unsedated C-EGD group. CONCLUSIONS Unsedated PEG placement using transoral UTE in ALS patients is a safe method.
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Affiliation(s)
- Yuichi Sato
- a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Satoshi Goshi
- a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Yusuke Kawauchi
- a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Yuuki Nishigaki
- a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Ken-Ichi Mizuno
- a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Satoru Hashimoto
- a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Manabu Takeuchi
- a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Masaaki Kobayashi
- b Division of Endoscopy , Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Tetsutaro Ozawa
- c Department of Neurology , Niigata University Brain Research Institute , Niigata , Japan
| | - Masatoyo Nishizawa
- c Department of Neurology , Niigata University Brain Research Institute , Niigata , Japan
| | - Yutaka Aoyagi
- a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
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Ahmed O, Jilani D, Sheth S, Giger M, Funaki B. Radiologically Guided Placement of Mushroom-retained Gastrostomy Catheters: Long-term Outcomes of Use in 300 Patients at a Single Center. Radiology 2015; 276:588-96. [PMID: 25775194 DOI: 10.1148/radiol.15141327] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess long-term outcomes including risk of complications and nutritional benefits of mushroom-retained (pull-type) gastrostomy catheters placed in patients by interventional radiologists. MATERIALS AND METHODS All patients who received pull-type gastrostomy tubes between 2010 and 2013 were retrospectively reviewed, including 142 men (average weight, 169.6 lb [76.32 kg]; mean age, 65.2 years; range, 22-92 years) and 158 women (average weight, 150.4 lb [67.68 kg]; mean age, 65.2 years; range, 18-98 years). Indications for placement were cerebrovascular accident (n = 80), failure to thrive (n = 71), other central nervous system disorder (n = 51), head and neck cancer (n = 47), and other malignancy (n = 51). Complications were recorded per Society of Interventional Radiology practice guidelines. Patient weight was documented at specific follow-up intervals. Statistical analysis was performed by using the Student t test and one-way analysis of variance for the effects of sex and indication for placement, respectively, on average weight change. RESULTS The technical success rate was 98.4% (300 of 305 patients). Major and minor complications occurred at a rate of 3.7% (n = 11) and 13% (n = 39), respectively. Follow-up weight during the early (≤45 days), intermediate (≤180 days), and long-term (>180 days) periods was available for 71% (n = 214), 36% (n = 108), and 15% (n = 44) of the 300 patients, respectively. Weight gain occurred in 77% (160 of 214), 60% (65 of 108), and 73% (32 of 44) of the patients, respectively. Patients who gained weight gained 6.7, 10.6, and 16.3 lb (3.02, 4.77, and 7.34 kg) during each follow-up period, respectively. Average weight gain at follow-up in all patients was 4.2, 0.6, and 5.4 lb (1.89, 0.27, and 2.43 kg), respectively. No significant differences in average weight change were seen among groups when they were classified according to sex or indication for placement. CONCLUSION Placement of mushroom-retained gastrostomy catheters is a viable long-term treatment option for enteral nutrition, with complication rates similar to those reported for other gastrostomy techniques. Improvement in nutrition status measured as weight gain was seen in most patients in both early and long-term periods.
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Affiliation(s)
- Osman Ahmed
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Danial Jilani
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Sujay Sheth
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Maryellen Giger
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Brian Funaki
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
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de Bucourt M, Collettini F, Althoff CE, Streitparth F, Greupner J, Hamm B, Teichgräber UK. CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients. Acta Radiol 2012; 53:285-91. [PMID: 22371622 DOI: 10.1258/ar.2011.110662] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. PURPOSE To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. MATERIAL AND METHODS A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka® Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. RESULTS The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. CONCLUSION Initial results suggest that the described technique under CT guidance is feasible and safe and may especially be advantageous in cases where endoscopic gastrostomy and sedation are contraindicated.
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Affiliation(s)
| | | | | | | | | | - Bernd Hamm
- Department of Radiology, Charité - University Medicine, Berlin
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