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White S, O'Cathain A, Halliday V, Bradburn M, McDermott CJ. Supporting people with Motor Neuron Disease (MND) to make decisions about gastrostomy feeding tube placement: a survey of UK healthcare professionals' practice and beliefs. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:290-298. [PMID: 38337170 DOI: 10.1080/21678421.2024.2314061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Understand the practice and beliefs of healthcare professionals (HCPs) supporting the decision-making of people with MND (pwMND) about gastrostomy placement, including identifying differences between professions. METHODS An online cross-sectional survey disseminated to HCPs who support the decision-making of pwMND about gastrostomy placement. RESULTS A total of 139 participants completed the survey including representation from a range of healthcare professions. A third (36/101, 36%) initiated discussions about gastrostomy later in practice than they believed was ideal. In relation to the outcome of declining compared to accepting gastrostomy, participants were more likely to discuss aspiration (80% vs. 68%), choking (76% vs. 58%) and prognosis (36% vs. 22%). Participants believed gastrostomies should be placed after a mean 8.1% weight loss since symptom-onset. More participants favored gastrostomy placement before pwMND presented with respiratory symptoms (45%) compared to onset of dysphagia (11%). Half believed pwMND placed gastrostomies too late. Participants were more likely to 'often'/'always' recommend pwMND to have a gastrostomy (23%) than continue without (7%) or decline (4%) gastrostomy, when believing these were the best option for pwMND. Nurses and dietitians discussed the broadest range of information, while doctors were more likely to discuss mortality risk and prognosis. CONCLUSION There is variation in HCPs practice and beliefs about initiating discussions, the sharing of information and recommendations, and timing, about gastrostomy placement. The information shared varies by profession and there is evidence of sub-optimal communication between HCPs. Further research is required to understand how these findings may impact on the decision-making of pwMND about gastrostomy.
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Affiliation(s)
- Sean White
- Division of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK, and
| | - Vanessa Halliday
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK, and
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2
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Talks BJ, Lynch N, Bowe I, Kelly C, Iqbal MS. A retrospective cohort study of reactive nasogastric tube feeding for head and neck cancer patients undergoing radiotherapy: Clinical and financial implications. Clin Otolaryngol 2024; 49:359-362. [PMID: 38421130 DOI: 10.1111/coa.14149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/13/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Benjamin James Talks
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Nola Lynch
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Isobel Bowe
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Charles Kelly
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Muhammad Shahid Iqbal
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
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Senesse P, Briant J, Boisselier P, Bensadoun RJ, Vinches M, Faravel K. Head and neck cancer patients treated with concomitant chemoradiotherapy involving the oral cavity and oropharynx: is another choice possible than prophylactic gastrostomy? Curr Opin Oncol 2024; 36:128-135. [PMID: 38573201 DOI: 10.1097/cco.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Recent recommendations on cachexia highlight, in head and neck cancers, the heterogeneity of studies, focusing on weight loss and sequelae including swallowing disorders. The current national guidelines emphasize that, in cases of concurrent chemoradiotherapy (cCRT) involving the oral cavity and oropharynx, prophylactic gastrostomy placement should be carried out systematically. We review why this technique is particularly relevant in this specific location for the feasibility of cCRT. RECENT FINDINGS A randomized trial is underway on swallowing disorders and the quality of life of patients after prophylactic vs. reactive gastrostomy in advanced oropharyngeal cancer patients treated with CRT. Concurrently, recent literature reviews emphasize the importance of the cumulative dose of chemotherapy for local control and survival. In cases of cCRT involving the oral cavity or the oropharynx, nutritional support could have a beneficial or detrimental impact on chemotherapy. SUMMARY Specifically for patients treated with cCRT involving the oral cavity and oropharynx, prophylactic gastrostomy would be able to fulfill the three objectives of local control, survival, and quality of life, minimizing complications related to nutritional support. Studies need to be more homogeneous. In clinical practice, nutrition should primarily assist in carrying out cancer treatment when survival is the main goal.
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Affiliation(s)
- Pierre Senesse
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
| | - Jeanne Briant
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
| | - Pierre Boisselier
- Institut du Cancer Montpellier (ICM), Radiotherapy Department, University of Montpellier, France
| | | | - Marie Vinches
- Institut du Cancer Montpellier (ICM), Medical Oncology Department, University of Montpellier, France
| | - Kerstin Faravel
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
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Stenson S, Capener R, Barker J, Hynes H, Barron E, Shakespeare C, Brampton-Mortley S, Skelton J, Cowell L, Hubbard GP. Evaluation of community nurse-led traumatic tube displacements. Br J Community Nurs 2024; 29:162-170. [PMID: 38564442 DOI: 10.12968/bjcn.2024.29.4.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Home enteral tube feeding (HEF) has many benefits and is largely safe practice. Some complications have historically required intervention in the acute setting, including traumatic displacement of feeding tubes (i.e. internal bumper/balloon removed intact), and evidence to support the safe replacement of these tubes in the community is lacking. To address this, a service enabling community homecare nurses (CHN) to replace traumatically displaced feeding tubes was designed and evaluated. Adult patients presenting with a traumatically displaced feeding tube over 29 months were included in the service evaluation. Baseline characteristics and outcomes at day 1, 7 and 6 months post-replacement were recorded. A total of 71 tube replacements were performed by CHNs in 60 patients. No clinical complications were recorded at any follow-up points. A simple cost analysis estimated savings of £235 754.40. These results suggest that nurse-led replacement of traumatically displaced feeding tubes in adults in the community is low-risk and offers potential cost savings.
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Affiliation(s)
| | | | - Julie Barker
- Nutrition and Dietetic Services, University Hospitals Bristol and Weston NHSFT
| | - Helen Hynes
- Dietetic Department, Home Enteral Feeding, Sheffield Teaching Hospitals NHSFT
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Bronswijk M, Christiaens P. A novel device for buried bumper syndrome management: not all roses and sunshine. Gastrointest Endosc 2024; 99:474. [PMID: 38368046 DOI: 10.1016/j.gie.2023.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden; Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven; Imelda Clinical GI Research Center, Bonheiden
| | - Paul Christiaens
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
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Elks W, McNickle AG, Kelecy M, Batra K, Wong S, Wang S, Angotti L, Kuhls DA, St Hill C, Saquib SF, Chestovich PJ, Fraser DR. Early Versus Late Feeding After Percutaneous Endoscopic Gastrostomy Placement in Trauma and Burn. J Surg Res 2024; 295:112-121. [PMID: 38006778 DOI: 10.1016/j.jss.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/13/2023] [Accepted: 10/28/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Timing to resume feeds after percutaneous endoscopic gastrostomy (PEG) placement continues to vary among US trauma surgeons. The purpose of this study was to assess differences in meeting nutritional therapy goals and adverse outcomes with early versus late enteral feeding after PEG placement. METHODS This retrospective review included 364 trauma and burn patients who underwent PEG placement. Data included patient characteristics, time to initiate feeds, rate feeds were resumed, % feed volume goals on postoperative days 0-7, and complications. Statistical analysis was performed comparing two groups (feeds ≤ 6 h versus > 6 h) and three subgroups (< 4 h, 4-6 h, ≥ 6 h) based on data quartiles. Chi-square/Fisher's exact test, independent-samples t-test, and one-way analysis of variance were used to analyze the data. RESULTS Mean time to initiate feeds after PEG was 5.48 ± 4.79 h. Burn patients received early feeds in a larger proportion. A larger proportion of trauma patients received late feeds. The mean % of goal feed volume met on postoperative day 0 was higher in the early feeding group versus the late (P < 0.001). There were no differences in adverse events, even after subgroup analysis of those who received feeds < 4 h after PEG placement. CONCLUSIONS Patients with early initiation of feeds after PEG placement achieve a higher percentage of goals on day 0 without an increased rate of adverse events. Unfortunately, patients routinely fall short of their target tube feeding goals.
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Affiliation(s)
- Whitney Elks
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada.
| | - Allison G McNickle
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Matthew Kelecy
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Shirley Wong
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Shawn Wang
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Lisa Angotti
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Deborah A Kuhls
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Charles St Hill
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Syed F Saquib
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Paul J Chestovich
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Douglas R Fraser
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
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7
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Robison RD, Patel S, Bunker J, Rudolph JL, Teno JM, Rogus-Pulia N. Pre-hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia. J Am Geriatr Soc 2024; 72:778-790. [PMID: 38156795 DOI: 10.1111/jgs.18729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Despite research demonstrating the risks of using feeding tubes in persons with advanced dementia, they continue to be placed. The natural history of dysphagia among patients with advanced dementia has not been examined. We conducted a secondary analysis of a national cohort of persons with advanced dementia staying at a nursing home stay before hospitalization to examine (1) pre-hospitalization dysphagia prevalence and (2) risk of feeding tube placement during hospitalization based on preexisting dysphagia. METHODS A retrospective cohort study consisting of all nursing home (NH) residents (≥66 years) with advanced dementia (Cognitive Function Scale score ≥2), a hospitalization between 2013-2017, and a Minimum Data Set (MDS) 3.0 assessment within 120 days before hospitalization. Pre-hospitalization dysphagia status and surgically placed feeding tube insertion during hospitalization were determined by MDS 3.0 swallowing items and ICD-9 codes, respectively. A multivariate logistic model clustering on hospital was used to examine the association of dysphagia with percutaneous endoscopic gastrostomy (PEG) feeding tube placement after adjustment for confounders. RESULTS Between 2013 and 2017, 889,983 persons with NH stay with advanced dementia (mean age: 84.5, SD: 7.5, and 63.5% female) were hospitalized. Pre-hospitalization dysphagia was documented in 5.4% (n = 47,574) and characterized by oral dysphagia (n = 21,438, 2.4%), pharyngeal dysphagia (n = 24,257, 2.7%), and general swallowing complaints/pain (n = 14,928, 1.7%). Overall, PEG feeding tubes were placed in 3529 patients (11.2%) with pre-hospitalization dysphagia, whereas 27,893 (88.8%) did not have pre-hospitalization dysphagia according to MDS 3.0 items. Feeding tube placement risk increased with the number of dysphagia items noted on the pre-hospitalization MDS (6 vs. 0 dysphagia variables: OR = 5.43, 95% CI: 3.19-9.27). CONCLUSIONS Based on MDS 3.0 assessment, only 11% of PEG feeding tubes were inserted in persons with prior dysphagia. Future research is needed on whether this represents inadequate assessment or the impact of potentially reversible intercurrent illness resulting in feeding tube placement.
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Affiliation(s)
- Raele Donetha Robison
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sweta Patel
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jennifer Bunker
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Joan M Teno
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
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8
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Zambelli L, Aumar M, Ley D, Antoine M, Coopman S, Morcel J, Bequet E, Guimber D, Cailliau E, Peretti N, Gottrand F. Home enteral nutrition does not decrease oral feeding in children during the first year of nutritional support. Clin Nutr 2024; 43:781-786. [PMID: 38340410 DOI: 10.1016/j.clnu.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Enteral nutrition is necessary when nutritional status is poor and oral intake is insufficient or impossible. Although it has been suspected to reduce spontaneous oral feeding, no study has formally assessed the influence of enteral nutrition on pediatric oral intake. The present study aimed to evaluate variation in oral feeding intake after enteral nutrition initiation, and to identify factors influencing oral feeding. METHODS This retrospective cohort study included 149 pediatric patients from two French tertiary care hospitals, who received home enteral nutrition from 2009 to 2022. The patients were aged 2 months to 17 years (median age 3 years, interquartile range 1.3-9.2). Oral and enteral intakes were assessed when enteral nutrition was initiated (M0), and again at M3 (n = 123), M6 (n = 129), and M12 (n = 134) follow-ups, based on dieticians' and home services' reports. Oral feeding and body mass index z score variations during follow-ups were evaluated using a linear mixed regression model, including "time" as a fixed effect and "patient" as a random effect. Factors associated with oral feeding changes were assessed using a model interaction term. RESULTS Oral intake did not vary significantly (P = 0.99) over time and accounted for 47.4% ± 27.4%, 46.9% ± 27.4%, 48.4% ± 28.2%, and 46.6% ± 26.9% of the ideal recommended daily allowance (calculated for the ideal weight for height) at M0, M3, M6, and M12, respectively. Delivery method (nasogastric tube versus gastrostomy), prematurity, underlying disease, history of intrauterine growth retardation, and speech therapy intervention did not influence oral intake. Administration (i.e., exclusively continuous nocturnal infusion versus daytime bolus) led to different oral intake development, although oral intake also differed at M0. CONCLUSIONS Enteral nutrition, although increasing total energy intake, does not alter oral feeding during the first year of administration. Only the mode of administration might influence oral intake.
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Affiliation(s)
- L Zambelli
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France; Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Liège University Hospital, Liège, Belgium.
| | - M Aumar
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - D Ley
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - M Antoine
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - S Coopman
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - J Morcel
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - E Bequet
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Liège University Hospital, Liège, Belgium.
| | - D Guimber
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - E Cailliau
- Biostatistics Department, CHU Lille, F-59000 Lille, France.
| | - N Peretti
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hospices Civils de Lyon, Lyon, France.
| | - F Gottrand
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
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Schwanstecher A, Arnold J. Gastrocutaneous fistula for decompression in chronic ileus caused by peritoneal carcinomatosis. Gastrointest Endosc 2024; 99:458-459. [PMID: 37748547 DOI: 10.1016/j.gie.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/12/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Annekatrin Schwanstecher
- Department of Gastroenterology, Diakonieklinikum Rotenburg, Rotenburg, Wümme, Lower Saxony, Germany
| | - Joachim Arnold
- Department of Gastroenterology, Diakonieklinikum Rotenburg, Rotenburg, Wümme, Lower Saxony, Germany
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Dibello J, Portal D, Greenstein J, Hahn B. Hidden in Plain Sight. J Emerg Med 2024; 66:e381-e382. [PMID: 38242751 DOI: 10.1016/j.jemermed.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/15/2023] [Indexed: 01/21/2024]
Affiliation(s)
- Jaclyn Dibello
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
| | - Daniel Portal
- Department of Radiology, Staten Island University Hospital, Staten Island, New York
| | - Josh Greenstein
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
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11
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Mahawongkajit P, Saengwijit A, Wongvisavavit P, Havanond C, Orrapin S. Anthropometric parameters as a predictor for abdominal wall thickness in a patient with gastrostomy. PLoS One 2024; 19:e0296818. [PMID: 38394301 PMCID: PMC10890720 DOI: 10.1371/journal.pone.0296818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/19/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Enteral feeding tubes play essential roles in clinical management and nutritional support. Knowledge of the abdominal wall is beneficial in surgical practice and safe for gastrostomy. Anthropometric parameters are currently used for clinical assessment in many clinical applications. That might be beneficial if we applied anthropometric measurement for thickness prediction of the abdominal wall to the schedule of patients' gastrostomy care. This study aimed to evaluate the anthropometric parameters of abdominal wall thickness (AWT). METHODS We conducted a cross-sectional study with anthropometric parameters and CT-measured anterior AWT were assessed and analyzed. RESULTS The data are collected from January 2020 to March 2021. Arm circumference and body mass index were strongly correlated with AWT at left upper quadrant area and anterior AWT at middle area. The data was created in an TAWT (Thammasat AWT) chart to represent body parameters to AWT. CONCLUSIONS Arm circumference is related to AWT. A TAWT chart is designed to help medical personnel evaluate the thickness of the abdominal wall and could guide estimating the gastrostomy tube length.
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Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Autchariya Saengwijit
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Poon Wongvisavavit
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chittinad Havanond
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Saritphat Orrapin
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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12
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Carlone G, Dubuis JB, Sgardello SD, Gussago S, Fournier I. Successful Conservative Management of Hepatic Portal Venous Gas Following Percutaneous Endoscopic Gastrostomy: A Case Report. Am J Case Rep 2024; 25:e942721. [PMID: 38327038 PMCID: PMC10862080 DOI: 10.12659/ajcr.942721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/29/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Hepatic portal venous gas (HPVG) is a rare radiologic finding mostly associated with life-threatening diseases like bowel necrosis, but can also be benign; its overall mortality rate is 39-75%. In rare cases HPVG is associated with endoscopic procedures such as percutaneous endoscopic gastrostomy (PEG) placement. However, due to the rarity of this condition, there is no recommendation about its management. The aim of this case report was to describe a successful conservative management of HPVG without antibiotic administration based on the clinical presentation. CASE REPORT A 78-year-old male patient known for a history of esophageal cancer treated with radio- and chemotherapy, complicated by a post-radiation esophageal stenosis requiring a PEG tube placement 1 month prior was admitted to our Emergency Department for vomiting and abdominal pain. A contrast-enhanced abdominal CT scan showed small-bowel dilatation without obstruction, as well as gastric wall pneumatosis and HPVG. We opted for a conservative approach. The PEG was put to suction for 2 days. The clinical evolution was favorable, with resolution of abdominal pain and a restored transit on day 2. A follow-up CT scan at day 5 showed resolution of HPVG. Nutrition through the PEG was restored at day 6 without complication. CONCLUSIONS HPVG can be a benign finding after a PEG tube placement. Conservative management without antibiotics can be used in oligosymptomatic and hemodynamically stable patients after life-threatening associated diseases like bowel necrosis have been ruled out.
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Affiliation(s)
- Giovanni Carlone
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
| | - Jean-Baptiste Dubuis
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Stefano Gussago
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Ian Fournier
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
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Chang-Ming H, Xiao-Mei Q, Li L, Qing-Hua L, Jun-Ru X, Liang-Shan L, Liang-Yu D, Xue-Quan H, Chuang H. Safety and efficacy of stoma site selection in CT-guided percutaneous gastrostomy: a retrospective analysis. World J Surg Oncol 2024; 22:45. [PMID: 38321485 PMCID: PMC10845744 DOI: 10.1186/s12957-024-03323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
PURPOSE To compare the safety and efficacy of CPG in the rectus abdominis and intercostal regions. MATERIALS AND METHODS This retrospective study included 226 patients who underwent CPG at a single center, with the stoma placed in the rectus abdominis or intercostal region. Surgical outcomes and complications, such as pain and infection within 6 months postoperatively, were recorded. RESULTS The surgical success rate was 100%, and the all-cause mortality rate within 1 month was 0%. An intercostal stoma was placed in 56 patients; a rectus abdominis stoma was placed in 170 patients. The duration of surgery was longer for intercostal stoma placement (37.66 ± 14.63 min) than for rectus abdominis stoma placement (30.26 ± 12.40 min) (P = 0.000). At 1 month postsurgery, the rate of stoma infection was greater in the intercostal group (32.1%) than in the rectus abdominis group (20.6%), but the difference was not significant (P = 0.077). No significant difference was observed in the infection rate between the two groups at 3 or 6 months postsurgery (P > 0.05). Intercostal stoma patients reported higher pain scores during the perioperative period and at 1 month postsurgery (P = 0.000), but pain scores were similar between the two groups at 3 and 6 months postsurgery. The perioperative complication rates for intercostal and rectus abdominis surgery were 1.8% and 5.3%, respectively (P = 0.464), with no significant difference in the incidence of tube dislodgement (P = 0.514). Patient weight improved significantly at 3 and 6 months postoperatively compared to preoperatively (P < 0.05). CONCLUSION Rectus abdominis and intercostal stomas have similar safety and efficacy. However, intercostal stomas may result in greater short-term patient discomfort.
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Affiliation(s)
- Hu Chang-Ming
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China
| | - Qi Xiao-Mei
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China
| | - Liu Li
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China
| | - Liang Qing-Hua
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China
| | - Xiong Jun-Ru
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China
| | - Li Liang-Shan
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China
| | - Deng Liang-Yu
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China
| | - Huang Xue-Quan
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China
| | - He Chuang
- Department of Nuclear Medicine (Treatment Center of Minimally Invasive Interventional), First Affiliated Hospital of Army Medical University, No. 30 of Gao Tanyan District, Chongqing, China.
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14
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WEO Newsletter: EUS-guided hepatico gastrostomy: Tips and tricks. Dig Endosc 2024; 36:256-9. [PMID: 38303666 DOI: 10.1111/den.14755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
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15
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Thukral S, Cline BC, Kim CY, Ronald J. Esophageal Balloon Air Insufflation to Facilitate Percutaneous Transesophageal Gastrostomy under Moderate Sedation. J Vasc Interv Radiol 2024; 35:321-323. [PMID: 38348497 DOI: 10.1016/j.jvir.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 02/15/2024] Open
Affiliation(s)
- Siddhant Thukral
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710
| | - Brendan C Cline
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710
| | - James Ronald
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710.
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16
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Choi KY, Patel SD, Lane C, Tucker J, Chan K, Pradhan S, Mahase SS, Tam SH, King TS. Elucidating survival and functional outcomes in patients with primary head and neck malignancies treated in academic versus community settings. Head Neck 2024; 46:398-407. [PMID: 38087455 DOI: 10.1002/hed.27588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/19/2023] [Accepted: 11/19/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Differences in treatment outcomes between community or academic centers are incompletely understood. METHODS Retrospective review of head and neck cancer patients between 2010 and 2020 in a rural health region. Kaplan-Meier curves and log-rank tests were used to evaluate survival outcomes, along with bivariate and multivariable Cox proportional hazards models. Linear regression was used for functional outcomes of tracheotomy and gastrostomy tube dependence. RESULTS Two hundred and forty-eight patients treated at an academic center were compared with 94 patients treated in community centers. In multivariable analysis, the risk of death (HR = 0.60, p = 0.019), and risk of recurrence were lower (HR = 0.29, p < 0.001) for patients treated in academic centers. Patients treated in community centers had longer gastrostomy tube dependence (p = 0.002). CONCLUSION Our findings suggest that treatment at an academic center was associated with a lower risk of recurrence and shorter gastrostomy tube dependence compared to treatment in the community.
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Affiliation(s)
- Karen Y Choi
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shivam D Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ciaran Lane
- Department of Otolaryngology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jacqueline Tucker
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kimberly Chan
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sean S Mahase
- Department of Radiation Oncology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Samantha H Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Center, Detroit, Michigan, USA
| | - Tonya S King
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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17
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Fujinaga Y, Mitoro A, Yoshiji H. Endoscopic hand suturing for nonhealing gastrocutaneous fistula after gastrostomy tube removal. Dig Endosc 2024; 36:230-231. [PMID: 37914675 DOI: 10.1111/den.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
Watch a video of this article.
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Affiliation(s)
- Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Akira Mitoro
- Division of Endoscopy, Nara Medical University, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
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18
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Hung ML, Shlansky-Goldberg RD. The Crossing Sword Technique: Stabilizing the Jejunum During Percutaneous Jejunostomy. Cardiovasc Intervent Radiol 2024; 47:265-267. [PMID: 37821777 DOI: 10.1007/s00270-023-03568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Matthew L Hung
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Richard D Shlansky-Goldberg
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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19
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Abdelhadi R, Lyman B, Pollard KG, Reddick C, Bonvechio J, Fleming B, Yeselson M. Troubleshooting pediatric gastrostomy-ENFit inaccuracies. Nutr Clin Pract 2024; 39:256-257. [PMID: 37933408 DOI: 10.1002/ncp.11072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Ruba Abdelhadi
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Nurse Consultant, Kansas City, USA
| | | | - Cynthia Reddick
- Home Enteral Nutrition Consultant, Sacremento, California, USA
| | - Jennifer Bonvechio
- Department of Pharmacy, Medication Safety, Akron Children's Hospital, Akron, Ohio, USA
| | - Barbara Fleming
- Neonatal Critical Care Unit, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Molly Yeselson
- Patient Advocate and Home Parenteral and Enteral Nutrition Consumer, Washington, District of Columbia, USA
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20
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Prakash J, Pardy C, Yardley I, Kelly V. Psychological and social impacts on carers of children with a gastrostomy: a systematic review. Pediatr Surg Int 2024; 40:44. [PMID: 38294568 DOI: 10.1007/s00383-023-05618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 02/01/2024]
Abstract
To determine the psychological and social impacts of a gastrostomy in childhood on carers and families. A systematic search of OVID, Medline and Embase was undertaken using the subject headings and word variants for 'gastrostomy', 'children' and 'carers'. Studies included were those describing the impact of gastrostomies in children on family and carers, published in English. 564 articles were identified. After exclusion of duplicates, abstract and full text screening, 25 were included. Carer anxiety increases in the period leading up to, and for a short period following gastrostomy insertion. 3-6 months following gastrostomy insertion, anxiety reduced (reduced State-Trait Anxiety Inventory scores), carer quality of life improved (higher Quality of Life Scale scores), and carer satisfaction with the child's gastrostomy increased (improved Satisfaction Questionnaire with Gastrostomy Feeding scores). Reported changes in carer quality of life in the longer term following a child's gastrostomy insertion were mixed. The social and psychological burden on caregivers of a gastrostomy in childhood varies over time. There is evidence that paediatric gastrostomies have positive effects on carers' psychological and social well-being; however, aspects of carers' quality of life remain impaired. Carer education and support are vital to reduce the burden placed on carers.
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Affiliation(s)
- Joe Prakash
- GKT King's College London Medical School, London, UK
| | - Caroline Pardy
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, SE1 7EH, UK.
| | - Iain Yardley
- GKT King's College London Medical School, London, UK
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, SE1 7EH, UK
| | - Veronica Kelly
- Childrens Health Ireland, Herberton, St James's Walk, Rialto, D08 HP97, Ireland
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21
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Özceylan G, Findik İ. Comparison of anxiety and depression levels in caregivers of patients with percutaneous endoscopic gastrostomy for home enteral tube feeding against other enteral nutrition methods. BMC Palliat Care 2024; 23:20. [PMID: 38247011 PMCID: PMC10802060 DOI: 10.1186/s12904-024-01360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The aim of the study was to demonstrate whether the care burden of caregivers of bedridden patients, who experience feeding difficulties, decreases according to the Hospital Anxiety and Depression Scale (HADS) (1) after the patient has undergone PEG (Percutaneous Endoscopic Gastrostomy). The hypothesis of the study was that the levels of anxiety and depression of caregivers for patients fed via PEG decrease more than those for caregivers of patients fed through other enteral methods. Based on this, the goal is to recommend to palliative care and home care professionals the type of feeding method for bedridden patients that will create less burden on their relatives. METHODS A comparison was made of the Hospital Anxiety and Depression Scale (HADS) scores among caregivers of patients receiving PEG and other enteral nutrition, focusing on changes between hospital admission and discharge. These changes were analyzed based on the caregiver's age, gender, and the duration of the patient's hospital stay. METHODS This study conducted a comparative analysis of the Hospital Anxiety and Depression Scale (HADS) scores among caregivers of patients receiving Percutaneous Endoscopic Gastrostomy (PEG) versus other forms of enteral nutrition. The focus was on the variation in these scores from the time of the patients' hospital admission to their discharge. This analysis incorporated an examination of how these changes correlated with the caregiver's age and gender, as well as the duration of the patient's hospitalization. RESULTS Despite longer hospital stays, a decrease in anxiety and depression was observed in caregivers of patients receiving PEG compared to the other group (p = 0.078). It was found that the decrease in anxiety and depression levels was less pronounced with increasing age of the caregiver (r=-0.202, p = 0.038). Hospital stay duration for patients receiving PEG was significantly longer than for those receiving other enteral nutrition methods (p = 0.017). CONCLUSIONS We believe that Percutaneous Endoscopic Gastrostomy (PEG) should be the preferred method for long-term enteral nutrition due to its facilitation of effective and comfortable feeding and medication administration by caregivers. In palliative care services, for patients requiring long-term nutrition, PEG should be considered more prominently than other enteral feeding methods to reduce the anxiety of caregivers.
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Affiliation(s)
- Gökmen Özceylan
- Tekirdağ DRIFC State Hospital palliative service, TekİrdaĞ, Turkey.
| | - İnahet Findik
- Tekirdağ DRIFC State Hospital palliative service, TekİrdaĞ, Turkey
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22
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Tae CH, Lee JY, Joo MK, Park CH, Gong EJ, Shin CM, Lim H, Choi HS, Choi M, Kim SH, Lim CH, Byeon JS, Shim KN, Song GA, Lee MS, Park JJ, Lee OY. Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy. Gut Liver 2024; 18:10-26. [PMID: 37850251 PMCID: PMC10791499 DOI: 10.5009/gnl230146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 10/19/2023] Open
Abstract
With an aging population, the number of patients with difficulty swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. Long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach, aided endoscopically, which may be an alternative to a nasogastric tube when enteral nutritional is required for 4 weeks or more. This paper is the first Korean clinical guideline for PEG. It was developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tubes removal for PEG based on the currently available clinical evidence.
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Affiliation(s)
- Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ju Yup Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Moon Kyung Joo
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Lim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sang Hoon Kim
- Department of Gastroenterology, Dongguk University Ilsan Hospital, Goyang, Korea
- Korean College of Helicobacter and Upper Gastrointestinal Research–Metabolism, Obesity & Nutrition Research Group, Seoul, Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Korean Society of Gastrointestinal Endoscopy–The Research Group for Endoscopes and Devices, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University College of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jong-Jae Park
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
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23
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Peiró I, Milla J, Arribas L, Hurtós L, González-Tampán AR, Bellver M, Fort E, Molina-Mata K, Joudanin JR, Valcarcel J, González-Barboteo J. Venting percutaneous radiologic gastrostomy in malignant bowel obstruction: safety and effectiveness in a comprehensive cancer centre. BMJ Support Palliat Care 2024; 13:e851-e854. [PMID: 36104161 DOI: 10.1136/spcare-2022-003895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/31/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Approximately 20% of established malignant bowel obstruction (MBO) patients do not respond to pharmacological treatment. In these cases, venting percutaneous radiologic gastrostomy (VPRG) may be useful. Existing evidence is based on retrospective studies with methodological limitations. The purpose of this study is to describe safety and effectiveness for symptom control after VPRG placement in a prospective cohort of MBO patients. METHODS Complications of VPRG placement, symptom control, destination on discharge and survival were analysed. RESULTS Twenty-one patients were included, 13 (61.9%) of whom were women. Mean age was 62.7 years (36-85). Local pain (n=8, 38.1%) and peristomal leakage (n=4, 19%) were the most frequent minor complications. No major complications occurred. Nausea and vomiting were relieved in most patients (n=20, 95.2%) after VPRG, and small quantities of liquid diet were introduced to these patients. Median time to death after VPRG was 13 days (IQR 8.6-17.4). Thirteen patients (61.9%) were discharged, with seven of them (33.3%) returning home. CONCLUSIONS When pharmacological treatment fails, the use of VPRG in MBO patients may be feasible, safe and effective.
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Affiliation(s)
- Inmaculada Peiró
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Jennifer Milla
- Palliative Care Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Lorena Arribas
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Laura Hurtós
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | | | - Marta Bellver
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Eduard Fort
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Kevin Molina-Mata
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Jonathan R Joudanin
- Department of Radiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Joana Valcarcel
- Department of Radiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Jesús González-Barboteo
- Bellvitge Institute for Biomedical Research, Barcelona, Spain
- Palliative Care Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
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24
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Patterson M, Greenley S, Ma Y, Bullock A, Curry J, Smithson J, Lind M, Johnson MJ. Inoperable malignant bowel obstruction: palliative interventions outcomes - mixed-methods systematic review. BMJ Support Palliat Care 2024; 13:e515-e527. [PMID: 38557409 PMCID: PMC10850628 DOI: 10.1136/bmjspcare-2021-003492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) and palliative venting gastrostomies (PVG) are two interventions used clinically to manage inoperable malignant bowel obstruction (MBO); however, little is known about their role in clinical and quality-of-life outcomes to inform clinical decision making. AIM To examine the impact of PN and PVG on clinical and quality-of-life outcomes in inoperable MBO. DESIGN A mixed-methods systematic review and narrative synthesis. DATA SOURCES The following databases were searched (from inception to 29 April 2021): MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Bielefeld Academic Search Engine, Health Technology Assessment and CareSearch for qualitative or quantitative studies of MBO, and PN or PVG. Titles, abstracts and papers were independently screened and quality appraised. RESULTS A total of 47 studies representing 3538 participants were included. Current evidence cannot tell us whether these interventions improve MBO survival, but this was a firm belief by patients and clinicians informing their decision. Both interventions appear to allow patients valuable time at home. PVG provides relief from nausea and vomiting. Both interventions improve quality of life but not without significant burdens. Nutritional and performance status may be maintained or improved with PN. CONCLUSION PN and PVG seem to allow valuable time at home. We found no conclusive evidence to show either intervention prolonged survival, due to the lack of randomised controlled trials that have to date not been performed due to concerns about equipoise. Well-designed studies regarding survival for both interventions are needed. PROSPERO REGISTRATION NUMBER CRD42020164170.
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Affiliation(s)
- Michael Patterson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sarah Greenley
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
| | - Yangmyung Ma
- Department of Plastic Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Alex Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jordan Curry
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jacquelyn Smithson
- Gastrointestinal and Liver services, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Michael Lind
- Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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25
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Hall NJ, Kitteringham L, Ron O, Stedman F, Stanton M, Wheeler R, Jones C, Smyth R, Keys C. A Minimally Interventional Approach to Oesophageal Atresia Repair With Early Enteral Feeding is Safe, Optimises Neonatal Outcomes, and Reduces Resource use. J Pediatr Surg 2024; 59:6-9. [PMID: 37867045 DOI: 10.1016/j.jpedsurg.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Recent series of newborn Oesophageal Atresia (OA) repair continue to report widespread use of chest drains, gastrostomy, routine contrast studies and parenteral nutrition (PN) despite evidence suggesting these are superfluous. We report outcomes using a minimally interventional approach to post-operative recovery. METHODS Ethically approved (15/WA/0153), single-centre, retrospective case-note review of consecutive infants with OA 2000-2022. Infants with OA and distal trache-oesophageal fistula undergoing primary oesophageal anastomosis at initial surgery were included (including those with comorbidities such as duodenal atresia, anorectal malformation and cardiac lesions). Our practice includes routine use of a trans-anastomotic tube (TAT), no routine chest drain nor gastrostomy, early enteral and oral feeding, no routine PN and no routine contrast study. Data are median (IQR). RESULTS Of total 186 cases of OA treated during the time period, 157 met the inclusion criteria of which 2 were excluded as casenotes unavailable. TAT was used in 150 infants. A chest drain was required in 13 (8%) and two infants had a neonatal gastrostomy. Enteral feeds were started on postoperative day 2 (2-3), full enteral feeds established by day 4 (4-6) and oral feeds started on day 5 (4-8). PN was required in 15%. Median postoperative length of stay was 10 days (8-17). Progress was quicker in term infants than preterm. One infant died of cardiac disease prior to neonatal discharge. Two planned post-operative contrast studies were performed (surgeon preference) and a further 7 due to clinical suspicion of anastomotic leak. Contrast study was therefore avoided in 94%. There were 2 anastomotic leaks; both presented clinically at day 4 and day 8 after oral feeds had been started. CONCLUSION Our minimally interventional approach is safe. It facilitates prompt recovery with lower resource use, reduced demand on nursing staff, reduced radiation burden, and early discharge home compared to published series without adversely affecting outcomes. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
| | - Lara Kitteringham
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Ori Ron
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Francesca Stedman
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Michael Stanton
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Robert Wheeler
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Ceri Jones
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Rachel Smyth
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Charles Keys
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
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Doyle C, Louw J, Shovlin A, Dowd L, Kavanagh M. Blended feeding in gastrostomy-fed children-A scoping review. Child Care Health Dev 2024; 50:e13222. [PMID: 38265135 DOI: 10.1111/cch.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/08/2023] [Accepted: 12/03/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Blended feeding has become increasingly prevalent in recent years with its practice gaining some momentum. With anecdotal reports of benefits and little evidence of harm in the literature regarding blended feeding, this scoping review was deemed important. The aim of this scoping review was to summarise the published evidence about blended feeding in gastrostomy-fed children. METHOD The scoping review methodology used included searches in specific online databases: PUBMED, PsychINFO, CINAHL, SCOPUS, AMED and EMBASE for articles that addressed issues pertaining to blended feeds in gastrostomy-fed children. Grey literature was also considered. Inclusion criteria included papers that pertained to information and research on blended feeding in gastrostomy-fed children. Studies published in English over the past 11 years (2011-2022) were included. This resulted in 59 papers being included in this scoping review. RESULTS Thematic analysis of the literature identified eight overall themes. It was clear that parents found blended feeding promoted the normalising of feeding, their own involvement in decision-making around foods and promotion of a socially inclusive mealtime. The need for dietician and health professional input and support is key, whereas a lack of guidelines acts as a barrier to blended feeding. Furthermore, risks associated with blended feeding are identified but also the benefits to the physical well-being of the child are considered. CONCLUSION The review was comprehensive in that it identified a broad range of literature, exploring the extent, range and nature of research activity related to the use of blended feeds. The lack of original research is a concern. However, it is expected this review will provide direction for researchers, and in particular inform policy and practitioners working in the field where blended feeds may be an option for gastrostomy-fed children.
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Affiliation(s)
- Carmel Doyle
- School of Nursing & Midwifery, Trinity College, Dublin, Ireland
| | - Julia Louw
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
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Lin IT, Bair MJ. Migrating gastrostomy tube. Gastrointest Endosc 2024; 99:117-118. [PMID: 37423529 DOI: 10.1016/j.gie.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/22/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Affiliation(s)
- I-Tsung Lin
- Division of Gastroenterology, Department of Internal Medicine, Taitung Branch of Mackay Memorial Hospital, Taitung, Taiwan
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Taitung Branch of Mackay Memorial Hospital, Taitung, Taiwan
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Zientek E, Rane S, Godfrey C, Sisson A, Dickinson KM. Factors guiding gastrostomy tube decision-making for caregivers of children with cystic fibrosis: a scoping review protocol. BMJ Open 2023; 13:e076539. [PMID: 38149423 PMCID: PMC10711882 DOI: 10.1136/bmjopen-2023-076539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/18/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION While ensuring appropriate growth is essential for all children, optimising nutritional status in children with cystic fibrosis (CF) is critical for improving health outcomes. Nutritional challenges in CF are multifactorial and malnutrition is common. While gastrostomy tubes (G-tubes) can improve weight status in individuals with CF, they also have common and chronic complications resulting in clinical equipoise. To date, factors influencing G-tube decision-making among caregivers of children with CF have not been systematically explored. This review aims to chart existing knowledge about caregivers' decisional needs related to G-tube placement, with a focus on caregivers of children with CF, as well as known medical and psychosocial benefits and risks of G-tube feedings in paediatric care. METHODS AND ANALYSIS This scoping review will follow the JBI methodological framework. We will include articles published between 1 January 1985 and 1 November 2023 in English and Spanish from MEDLINE (Ovid), Embase, CINAHL, PsycInfo, Cochrane Database of Systematic Reviews and Web of Science related to G-tube decision-making. Articles published in languages besides English and Spanish will be excluded. Articles will be screened for final eligibility and inclusion according to title and abstract, followed by full texts. Articles will be independently reviewed by two reviewers and any disagreements discussed with a third reviewer for consensus. We will map themes and concepts, and data extracted will be presented in tabular, diagrams and descriptive summaries. ETHICS AND DISSEMINATION As a form of secondary analysis, scoping reviews do not require ethics approval. This review will inform future research with caregivers involved in G-tube decision-making for children with CF. The final review will be submitted to a peer-reviewed scientific journal, disseminated at relevant academic conferences and will be shared with patients and clinicians. TRIAL REGISTRATION NUMBER Center for Open Science. https://osf.io/g4pdb.
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Affiliation(s)
- Emily Zientek
- Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Sanika Rane
- Baylor College of Medicine, Houston, Texas, USA
| | | | - Amy Sisson
- Texas Medical Center, Houston, Texas, USA
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Leung AC, Nahmias JT, Roman KM, Kirby KA, Qazi AS, Joe VC. Unnecessary Early Gastrostomy for Trauma Patients. Am Surg 2023; 89:6338-6341. [PMID: 37148330 DOI: 10.1177/00031348231173986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
While early gastrostomy tube placement (GTP) may decrease hospital length of stay and facilitate disposition, GTP may be unnecessary as some patients regain the ability to eat earlier than expected. No guidelines currently exist regarding optimal GTP timing or minimum duration of need indicating appropriateness of GTP. This retrospective (9/2017-12/2019) single center study evaluated the incidence of adequate (>75%) oral caloric intake (ACI) after GTP during index hospitalization and associated characteristics before discharge. Bivariate analyses were performed to compare patients achieving ACI and patients not achieving ACI at discharge. By discharge, 10 (12.5%) patients achieved ACI and 6 (7.5%) had their GT removed prior to discharge suggesting many patients undergo unnecessary GTP. Also, 6 (7.5%) patients suffered GTP-related complications. Future multicenter studies are needed to corroborate these findings and establish GTP guidelines for trauma patients to avoid unnecessary GT procedures and associated morbidities.
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Affiliation(s)
- Amanda C Leung
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Jeffry T Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Kelsey M Roman
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Katharine A Kirby
- Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA, USA
| | - Alliya S Qazi
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Victor C Joe
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA, USA
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Zhou X, Hu Z, Liu X, Zhang S, Xing Z, Liu J. A Promising Pancreatic Anastomosis to End Postoperative Pancreatic Fistula? Application of New Pancreatico gastrostomy in Laparoscopic Pancreaticoduodenectomy. Am Surg 2023; 89:6384-6386. [PMID: 37670421 DOI: 10.1177/00031348231200668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Affiliation(s)
- Xinbo Zhou
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zixuan Hu
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - XueQing Liu
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shubin Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongqiang Xing
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianhua Liu
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Cooke E, Kaplan H. How Should Technology-Dependent Patients' Care Be Managed Collaboratively to Avoid Turfing? AMA J Ethics 2023; 25:E878-884. [PMID: 38085990 DOI: 10.1001/amajethics.2023.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Technology-dependent patients require interventions (eg, tracheostomies, gastrostomy tubes, or total parenteral nutrition) to survive. Such patients are commonly "turfed" between general services or from subspecialty to general services within the hospital. This case commentary proposes several explanations for why technology-dependent patients are particularly susceptible to turfing, including clinicians' lack of familiarity with managing patients' technology, bias and ableism, and quality-of-life quandaries. It also addresses ways to combat turfing of technology-dependent patients and proposes educational strategies for managing common problems in the care of technology-dependent patients.
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Affiliation(s)
- Emma Cooke
- Internal medicine and pediatrics resident at Baylor College of Medicine in Houston, Texas
| | - Holland Kaplan
- Assistant professor of medical ethics and general internal medicine at the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston, Texas
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Hommel S, Lücke T, Schmidt-Choudhury A. Nutritional Management in Children and Adolescents with Severe Neurological Impairment-Who Cares? A Web-Based Survey Among Pediatric Specialists in Germany. Neuropediatrics 2023; 54:371-380. [PMID: 37607575 DOI: 10.1055/s-0043-1772708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Nutritional management of children and adolescents with severe neurological impairment (SNI) is challenging. A web-based survey was distributed to identify the present situation and the knowledge of the involved medical professionals in Germany. METHODS The survey was created with LimeSurvey, and access data were distributed by several medical societies. Eighty-three questions covered four topics: "general information," "gastro- and jejunostomy procedure," "handling of gastrostomies and feeding tubes," and "nutritional management and follow-up of children and adolescents with SNI." A descriptive analysis was performed with Microsoft Excel. RESULTS A total of 156 participated (65 completed and 91 partially), 27% being pediatric gastroenterologists, 23% pediatric neurologists, and 10% pediatric surgeons. The most common indications for gastrostomy and tube feeding were oropharyngeal dysfunction and failure to thrive. Many patients were still underweight after some months of enteral feeding. The procedure of gastrostomy and handling recommendations varied broadly. Frequently, standard operating procedures (SOPs) and written local guidelines did not exist, and there was a considerable request for training. Only 53% of participants were aware of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition position paper published in 2017, even fewer (38%) followed the guidelines. The recommended measures to assess a nutritional status were often not respected. CONCLUSION Nutritional management of children and adolescents with SNI in Germany is still strongly deficient. Despite the international guideline of 2017, few colleagues are aware of and adhere to the recommendations. This could be improved by interdisciplinary teaching and evaluation of the reasons for noncompliance. The procedure of gastrostomy and the patients' follow-up vary widely. Therefore, modified SOPs should be developed.
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Affiliation(s)
- Sara Hommel
- Department of Pediatric Gastroenterology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
| | - T Lücke
- Department of Pediatric Neurology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
| | - A Schmidt-Choudhury
- Department of Pediatric Gastroenterology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
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Tsunematsu M, Sugita K, Odaira H, Ikegami T, Washida N, Suzuki Y. Feasibility and Safety of Laparoscopic Placement of Peritoneal Dialysis Catheter Using Percutaneous Endoscopic Gastrostomy Device. Am Surg 2023; 89:6203-6205. [PMID: 35763591 DOI: 10.1177/00031348221111520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We developed a novel technique of peritoneal dialysis (PD) catheter placement using an existing device originally utilized to insert a percutaneous endoscopic gastrostomy tube. We investigated the feasibility and safety of the procedure. This study included 21 consecutive patients who underwent laparoscopic placement of PD catheter between August 2021 and December 2021. We retrospectively investigated the clinical variables and perioperative results. The laparoscopic procedure was successfully performed in all patients. The duration of surgery was 21 (18-37) minutes. All patients could start PD within the seventh postoperative day. However, 1 patient had peri-catheter leakage due to exit-site infection. There were no patients with catheter migration, catheter obstruction, peritonitis, procedure-related death, and withdrawal of PD. The laparoscopic placement PD catheter using percutaneous endoscopic gastrostomy device was feasible and safe. (128 words).
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Affiliation(s)
- Masashi Tsunematsu
- Department of Surgery, The International University of Health and Welfare, Japan
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Japan
| | - Kazuya Sugita
- Department of Nephrology, The International University of Health and Welfare, Japan
| | - Hironori Odaira
- Department of Surgery, The International University of Health and Welfare, Japan
| | - Toru Ikegami
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Japan
| | - Naoki Washida
- Department of Nephrology, The International University of Health and Welfare, Japan
| | - Yutaka Suzuki
- Department of Surgery, The International University of Health and Welfare, Japan
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Sajatovic M, Patel A, Hebert M, Mar A, Moore R, Bristow A, Farahmand K, Siegert S. Crushing the Contents of Valbenazine Capsules for Potential Addition to Soft Foods or Administration via Gastrostomy Tube. Clin Ther 2023; 45:1222-1227. [PMID: 37953076 DOI: 10.1016/j.clinthera.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE One-capsule, once-daily valbenazine is approved for tardive dyskinesia and under evaluation for chorea associated with Huntington's disease, conditions in which patients often experience dysphagia. In vitro studies were conducted to assess the suitability of crushing the contents of valbenazine capsules (40 and 80 mg) for mixing with soft foods or liquids or administration via a gastrostomy tube (G-tube). METHODS In study 1, the dissolution of whole valbenazine capsules and crushed capsule contents were measured serially for 1 hour. In study 2, valbenazine recovery was evaluated after crushed contents were mixed with soft foods, buffer solutions (pH range, 1.2-6.8), and fed-state simulated gastric fluid. In study 3, valbenazine recovery was evaluated after crushed contents were dispersed in water and delivered via a G-tube. In studies 2 and 3, acceptable valbenazine recovery was 90% to 110%. FINDINGS Study 1 indicated rapid and complete drug release for whole valbenazine capsules and crushed capsule contents, with similar release at 10 minutes (whole, 94%-99%; crushed, 98%-100%) and 60 minutes (whole, 101%-103%; crushed, 101%-102%). Study 2 found acceptable valbenazine recovery within 2 hours of adding crushed capsule contents to tested foods, buffers, or fed-state simulated gastric fluid (recovery, 92%-102%). Study 3 found acceptable valbenazine recovery when crushed contents were added to cold or hot water and delivered via G-tube, with a water cup rinse to capture residual contents (recovery, 91%-97%). IMPLICATIONS These studies indicate the potential viability of valbenazine formulation(s) that can be added to soft foods or liquids or delivered via G-tube. Such formulations will be important for individuals who require treatment with a vesicular monoamine transporter 2 inhibitor but cannot swallow whole pills.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Amita Patel
- Institute for Psychiatric Education, Dayton, Ohio
| | - Mello Hebert
- Neurocrine Biosciences Inc, San Diego, California
| | | | | | - Ali Bristow
- Neurocrine Biosciences Inc, San Diego, California
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Yu J, Sullivan BG, Nguyen NT, Hohmann SF, Harris AH, Micic D, Turaga KK, Senthil M, Eng OS. Readmission and Disposition in Patients With Malignant Bowel Obstructions Following Gastrostomy Tube. Am Surg 2023; 89:5915-5920. [PMID: 37257144 DOI: 10.1177/00031348231180915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Patients with peritoneal carcinomatosis (PC) can develop malignant bowel obstructions (MBOs) requiring inpatient admission and nasogastric tube decompression. Palliative decompressive gastrostomy tubes (G-tubes) may affect patient disposition, allowing for self-management and reduction in inpatient services. Therefore, we sought to assess disposition and inpatient readmission rates in patients admitted with PC and MBO following G-tube placement. METHODS The Vizient® Clinical Data Base was queried for inpatient admissions from October 2018 to May 2022 utilizing ICD-10 codes to identify patients admitted with PC and bowel obstruction, with or without G-tube placement. Demographics and hospital outcomes were recorded. Descriptive statistics and multivariate logistic regression analysis were performed. RESULTS From 750 patients, 59 (7.9%) had a G-tube placed. Compared to patients without G-tubes, those with G-tubes had lower rates of disposition to home (32.2% vs 70.0%, P < .001) and higher rates of disposition to hospice (home: 30.5% vs 7.8%, P < .001, facility: 10.2% vs 3.9%, P = .02). There was no significant difference in the rate (17.3% vs 22.3%, P = .40) or risk (OR = 1.44, 95% CI .69-3.01) of 30-day readmissions with G-tubes. However, palliative care consultation (OR 33.77, 95% CI 19.16-59.52) and G-tube placement (OR 5.82, 95% CI 2.56-13.25) were independent predictors for hospice. DISCUSSION Placement of G-tubes in patients with PC and MBO was associated with higher rates of disposition to hospice but there is no difference in 30-day readmission rates compared to those without G-tubes. Further prospective studies are needed to understand the role of G-tube placement in patients with MBO in relation to outcomes and disposition.
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Affiliation(s)
- Jingjing Yu
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Brittany G Sullivan
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Samuel F Hohmann
- Center for Advanced Analytics and Informatics, Vizient, Inc., Chicago, IL, USA
| | - Alyssa H Harris
- Center for Advanced Analytics and Informatics, Vizient, Inc., Chicago, IL, USA
| | - Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, Yale University, New Haven, CT, USA
| | - Maheswari Senthil
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Oliver S Eng
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
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Lim JS, Jung GS, Oh KS, Seo KW, Jung K, Yun JH. Percutaneous radiologic gastrostomy with single gastropexy using balloon-assisted tract dilatation: comparison with peel-away sheath. Diagn Interv Radiol 2023; 29:813-818. [PMID: 37650523 PMCID: PMC10679556 DOI: 10.4274/dir.2023.232342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous radiologic gastrostomy (PRG) with balloon-assisted tract dilatation (BATD) using a single gastropexy. METHODS This retrospective study was approved by the institutional review board. From August 2018 to October 2022, 61 patients (53 male and 8 female, mean age 67 years, age range 27-90 years) underwent PRG with balloon-retained tubes for enteral nutrition. Single gastropexy was performed in all cases. Patients were divided into two groups based on the tract dilatation technique used. In the first group, BATD (n = 48) was performed. In the second group, a 24-Fr peel-away sheath (PAS) was used for tract dilatation (n = 13). Patient demographics, technical success rate, clinical success rate, fluoroscopy time, cumulative radiation dose, and complications were retrospectively evaluated. The Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables were performed to compare the two groups. RESULTS All procedures were successfully performed with 100% technical and clinical success rates in both groups. The mean fluoroscopy time for the BATD group vs. the PAS group (1.68 ± 0.93 min vs. 3.56 ± 2.41 min, P < 0.001) and mean cumulative radiation dose (12.98 ± 9.28 mGy vs. 33.01 ± 15.14 mGy, P < 0.001) were significantly lower in the BATD group compared with the PAS group. There was one major complication of peritonitis that led to death in the PAS group (1/13, 7.7%) and no major complications in the BATD group. Minor complications such as pneumoperitoneum, abdominal pain, leakage, and balloon deflation occurred in 16 patients: 12 (12/48, 25.0%) patients in the BATD group and 4 (4/13, 38.5%) patients in the PAS group. The overall rate of major and minor complications was higher in the PAS group but did not show statistically significant differences (odds ratio: 1.875, 95%; confidence interval: 0.514-6.841, P = 0.486). CONCLUSION BATD using a single gastropexy is a safe and effective technique for PRG.
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Affiliation(s)
- Ji Su Lim
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
| | - Gyoo Sik Jung
- Department of Radiology, Ulsan Hospital, Ulsan, Korea
| | - Kyung Seung Oh
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jong Hyouk Yun
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
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Baumrucker SJ, VandeKieft G, Smith ER, Stolick M, Jefferson V, Boyles SP, Thatcher KL, Leach RJ. Ethics Roundtable: Advance Directives, Autonomy, and Gastrostomy Placement. Am J Hosp Palliat Care 2023; 40:1285-1291. [PMID: 36373275 DOI: 10.1177/10499091221139823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
CL is a 94-year-old male who is brought to the Emergency Department from an assisted living facility due to a new onset of weakness and altered mental status. He was in his usual state of moderately compensated health, requiring assistance for most activities of daily living due to medical frailty and a previous right brain CVA with residual mild left sided weakness. On the day of admission, the staff found him lethargic and disoriented. The family requested a surgical consult for percutaneous, endoscopic, gastrostomy (PEG) tube placement. A review of the patient's records showed that the patient had refused a PEG tube during his last two hospitalizations. During the last admission, the hospitalist documented that the patient repeatedly refused nutritional support stating "if it's my time, I've lived a full life. I'm ready to die and join my wife." There was no advance care plan ("living will"), but CL did sign a "Selection of Surrogate Decision-maker" form previously, assigning his nephew as primary surrogate. Under pressure from multiple family members, including the designated surrogate, the attending requested a surgical consultation. The surgical team determined that the patient did not have capacity and scheduled CL for PEG tube placement. The care team had concerns regarding the conflict between the patient's previously (and consistently) stated desires and the family's wishes; an ethics consult was requested.
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Affiliation(s)
| | | | | | - Matt Stolick
- Department of Philosophy, University of Findlay, Findlay, OH, USA
| | | | - Scott P Boyles
- Spiritual Health, Ballad Health System, Johnson City, TN, USA
| | - Kristin L Thatcher
- Internal Medicine Residency Program, Norton Community Hospital, Norton, VA, USA
| | - Rebecca J Leach
- East Tennessee State - Quillen College of Medicine, Johnson City, TN, USA
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Murphy N, Ravikumara M, Butterworth M, Glasson E, Rennison C, Prevett B, Fitzpatrick J, Phillips W, Burton C, Downs J. A Co-Designed Online Education Resource on Gastrostomy Feeding for Parents and Caregivers to Support Clinical Care. J Pediatr Gastroenterol Nutr 2023; 77:672-678. [PMID: 37612813 DOI: 10.1097/mpg.0000000000003925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Children with complex needs and severe disability may undergo gastrostomy insertion to support feeding difficulties. Parent education programs are critical components of clinical care pathways but there is little information on parent-reported educational needs. This study describes the collaborative process that yielded a resource to assist parents considering gastrostomy tube placement for their children, and the evaluation of the resource. METHODS A qualitative descriptive study was conducted to identify parent needs for gastrostomy education. Based on these data and codesigning with parents with a child with gastrostomy tube, an online resource comprising video and written materials was developed. Twenty parents then evaluated its suitability for parent learning. RESULTS Data describing parent needs were coded into categories which represented the gastrostomy "journey"-Decision Making, Hospital Stay and Living with Gastrostomy. Called Nourish , the gastrostomy training resource comprised 19 videos and 18 accompanying worksheets. Twenty parent caregivers rated it highly for its support for learning, confidence building, and planning. CONCLUSION The process that created Nourish generated a useful resource for parents considering or managing gastrostomy tube feedings for their child. Positive feedback suggests that this approach could be a valuable adjunct to clinical care.
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Affiliation(s)
- Nada Murphy
- From Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Madhur Ravikumara
- the Department of Gastroenterology, Perth Children's Hospital, Perth, Australia
| | | | - Emma Glasson
- From Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Catherine Rennison
- From Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Bree Prevett
- the Department of Gastroenterology, Perth Children's Hospital, Perth, Australia
| | - Jayne Fitzpatrick
- the Department of Gastroenterology, Perth Children's Hospital, Perth, Australia
| | - Wayne Phillips
- the Department of Paediatrics, Fairfield Hospital, Sydney, Australia
| | - Christel Burton
- Access Assistant Program, Disability Services, Women's and Children's Health Network, Adelaide, Australia
| | - Jenny Downs
- From Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Australia
- the Curtin School of Allied Health, Curtin University, Perth, Australia
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Grund KE, Zipfel A, Duckworth-Mothes B, Jost WH. Optimised endoscopic access for intrajejunal levodopa application in idiopathic Parkinson's syndrome. J Neural Transm (Vienna) 2023; 130:1383-1394. [PMID: 36809488 PMCID: PMC10645636 DOI: 10.1007/s00702-023-02601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
Pump-guided intrajejunal levodopa administration is one of the indispensable forms of therapy in advanced Parkinson's syndrome, along with deep brain stimulation and subcutaneous apomorphine injection. The standard application of levodopa gel via a JET-PEG, i.e. a percutaneous endoscopic gastrostomy (PEG) with an inserted internal catheter into the jejunum, has not been unproblematic due to the restricted absorption area of the drug in the region of the flexura duodenojejunalis and especially due to the sometimes considerable accumulated complication rates of a JET-PEG. Causes of complications are mainly a non-optimal application technique of PEG and internal catheter as well as the often missing adequate follow-up care. This article presents the details of a-compared to the conventional technique-modified and optimised application technique, which has been clinically proven successfully for years. However, many details derived from anatomical, physiological, surgical and endoscopic aspects must be strictly observed during the application to reduce or avoid minor and major complications. Local infections and buried bumper syndrome cause particular problems. The relatively frequent dislocations of the internal catheter (which can ultimately be avoided by clip-fixing the catheter tip) also prove to be particularly troublesome. Finally, using the Hybrid technique, a new combination of an endoscopically controlled gastropexy with 3 sutures and subsequent central thread pull-through (TPT) of the PEG tube, the complication rate can be dramatically reduced and thus a decisive improvement achieved for patients. The aspects discussed here are highly relevant for all those involved in the therapy of advanced Parkinson's syndrome.
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Affiliation(s)
- K E Grund
- Surgical and Experimental Endoscopy, University Hospital of Tübingen, Tübingen, Germany.
- , Gottwollshaeuser Steige 25, 74523, Schwaebisch Hall, Germany.
| | - A Zipfel
- Surgical and Experimental Endoscopy, University Hospital of Tübingen, Tübingen, Germany
| | - B Duckworth-Mothes
- Working Group for Experimental Endoscopy, Education and Training, Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - W H Jost
- Parkinson-Klinik Ortenau, Wolfach, Germany
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Jenkins DD, Moss HG, Adams LE, Hunt S, Dancy M, Huffman SM, Cook D, Jensen JH, Summers P, Thompson S, George MS, Badran BW. Higher Dose Noninvasive Transcutaneous Auricular Vagus Nerve Stimulation Increases Feeding Volumes and White Matter Microstructural Complexity in Open-Label Study of Infants Slated for Gastrostomy Tube. J Pediatr 2023; 262:113563. [PMID: 37329979 PMCID: PMC11000235 DOI: 10.1016/j.jpeds.2023.113563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To determine whether transcutaneous auricular vagus nerve stimulation (taVNS) paired with twice daily bottle feeding increases the volume of oral feeds and white matter neuroplasticity in term-age-equivalent infants failing oral feeds and determined to need a gastrostomy tube. STUDY DESIGN In this prospective, open-label study, 21 infants received taVNS paired with 2 bottle feeds for 2 - 3 weeks (2x). We compared 1) increase oral feeding volumes with 2x taVNS and previously reported once daily taVNS (1x) to determine a dose response, 2) number of infants who attained full oral feeding volumes, and 3) diffusional kurtosis imaging and magnetic resonance spectroscopy before and after treatment by paired t tests. RESULTS All 2x taVNS treated infants significantly increased their feeding volumes compared with 10 days before treatment. Over 50% of 2x taVNS infants achieved full oral feeds but in a shorter time than 1x cohort (median 7 days [2x], 12.5 days [1x], P < .05). Infants attaining full oral feeds showed greater increase in radial kurtosis in the right corticospinal tract at the cerebellar peduncle and external capsule. Notably, 75% of infants of diabetic mothers failed full oral feeds, and their glutathione concentrations in the basal ganglia, a measure of central nervous system oxidative stress, were significantly associated with feeding outcome. CONCLUSIONS In infants with feeding difficulty, increasing the number of daily taVNS-paired feeding sessions to twice-daily significantly accelerates response time but not the overall response rate of treatment. taVNS was associated with white matter motor tract plasticity in infants able to attain full oral feeds. TRIAL REGISTRATION Clinicaltrials.gov (NCT04643808).
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Affiliation(s)
- Dorothea D Jenkins
- Department of Pediatrics at the Medical University of South Carolina, Charleston, SC; Department of Neuroscience, Medical University of South Carolina, Charleston, SC.
| | - Hunter G Moss
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC
| | - Lauren E Adams
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Sally Hunt
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Morgan Dancy
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Sarah M Huffman
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Daniel Cook
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jens H Jensen
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Philipp Summers
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Sean Thompson
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - Mark S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Bashar W Badran
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC; Neuro-X Lab, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Gong J, Liu X, Wang G, Li W, Luo G, Lin Y, Zhang B, Chen C. Uncut interposed jejunum pouch versus esophago- gastrostomy and double anastomoses of jejunum to the esophagus and residual stomach: An innovative method of digestive tract reconstruction following proximal gastrectomy. Asian J Surg 2023; 46:4196-4201. [PMID: 36456439 DOI: 10.1016/j.asjsur.2022.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
AIM An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double anastomosis(Uncut-D), was established in recent years. In order to fully clarify the superiority of the procedure, this study has conducted a systematic analysis and thorough discussion. METHODS 118 patients with adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy were enrolled in this study. According to the methods of digestive tract reconstruction, these patients were divided into three groups: Uncut-D(n = 43), esophagogastrostomy (EG, n = 36), jejunal interposition (JI, n = 39).The preoperative indicators, surgical complications and related indicators of postoperative quality of life were analyzed. RESULTS There were no significant differences in preoperative data among all groups (P > 0.05); The digestive tract reconstruction time in Uncut-D group was more than that in EG group, and less than that in JI group (P < 0.05). The incidence of esophageal anastomotic stenosis in Uncut-D group was significantly lower than that in EG group (P < 0.05); In Uncut-D group, the incidence of reflux esophagitis, postoperative nutrition index(PNI), weight recovery and Visick classification were significantly better than those in EG group (P < 0.05), furthermore, the incidence of delayed gastric emptying,PNI and weight recovery were better than those in JI group (P < 0.05). CONCLUSIONS The Uncut-D procedure gave full play to jejunal continuity and the advantages of pouch, and played a valuable role in gastric and cardiac replacement, which significantly reduced long-term complications, improved postoperative nutritional status of patients and long-term quality of life.
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Affiliation(s)
- JiaQing Gong
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China.
| | - Xia Liu
- Department of Medical Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - GuangLan Wang
- Department of Ultrasound,The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Wei Li
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - GuoDe Luo
- Department of General Surgery, The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Yan Lin
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - Bin Zhang
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - ChuanDong Chen
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
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van Eenennaam RM, Rave N, Kruithof WJ, Kruitwagen-van Reenen ET, van den Berg LH, Visser-Meily JA, Beelen A. Control in the absence of choice: A qualitative study on decision-making about gastrostomy in people with amyotrophic lateral sclerosis, caregivers, and healthcare professionals. PLoS One 2023; 18:e0290508. [PMID: 37682899 PMCID: PMC10490981 DOI: 10.1371/journal.pone.0290508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/10/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Gastrostomy is recommended in amyotrophic lateral sclerosis for long-term nutritional support, however, people with amyotrophic lateral sclerosis and healthcare professionals perceive decision-making as complex. METHOD To explore their perspectives on decision-making regarding gastrostomy, we used semi-structured interviews with people with amyotrophic lateral sclerosis, who had made a decision, and their caregivers; healthcare professionals were interviewed separately. Interviews were transcribed and analyzed thematically. RESULTS In 14 cases, 13 people with amyotrophic lateral sclerosis and 12 caregivers were interviewed; and in 10 of these cases, 5 healthcare professionals. Participants described decision-making on gastrostomy as a continuous process of weighing (future) clinical need against their values and beliefs in coming to a decision to accept or reject gastrostomy, or to postpone decision-making, while being supported by loved ones and healthcare professionals. Participants described gastrostomy as inevitable, but retained agency through control over the timing of decision-making. They said physical necessity, experiences of loss and identity, and expectations about gastrostomy placement were important factors in decision-making. Decision-making was described as a family affair, with caregivers supporting patient choice. healthcare professionals supported people with amyotrophic lateral sclerosis during the decision-making process and respected their autonomy and values. People with amyotrophic lateral sclerosis stressed the importance of adequate information on the procedure and the benefits. CONCLUSION People with amyotrophic lateral sclerosis feel in control of decision-making on gastrostomy if they are able to make their own choice at their own pace, supported by loved ones and healthcare professionals. Person-centered decision-making on gastrostomy requires early information exchange and repeated discussions with people with amyotrophic lateral sclerosis and their caregivers, incorporating their values and respecting patient choice.
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Affiliation(s)
- Remko M. van Eenennaam
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Neele Rave
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Willeke J. Kruithof
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Esther T. Kruitwagen-van Reenen
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Leonard H. van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna A. Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Fabricius J, Pedersen AR. Subacute prognosis of oral nutrition (SPOON): Development of a multivariable prognostic model for complete oral intake in tube-fed subjects with acquired brain injury. Clin Nutr 2023; 42:1770-1777. [PMID: 37572580 DOI: 10.1016/j.clnu.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND & AIMS Enteral feeding is very common following an acquired brain injury. However, no prognostic models for oral food intake have been developed for subacute rehabilitation. The aim of this study was to develop a prognostic model and online tool, coined "subacute prognosis of oral nutrition" (SPOON), for complete oral intake in tube-fed subjects with acquired brain injury. METHODS The model was developed using routinely gathered clinical data from a cohort of 1233 adult patients who were tube-fed at admission for sub-acute inpatient rehabilitation. Candidate predictors were included based on scientific evidence and their availability in the medical records within the first days following admission. The outcome was time until achieving complete oral food intake without any tube-feeding supplements. Time until complete oral intake was analyzed by discrete time-to-event analysis with logit-link and presented as daily odds ratios (OR) with 95% confidence intervals (CI). RESULTS The following predictors of complete oral intake were included in the model: age, diagnosis, cuffed tracheostomy tube, days from injury to admission for rehabilitation, and the Early Functional Abilities (EFA) sum score. Multiple adjusted analyses were performed stratified by cuffed tracheostomy tube status. Some of the strongest predictors of complete oral intake were age 18-40 years, OR 1.99 (95%CI: 1.53; 2.59); 0-2 weeks since injury, OR 3.75 (95%CI: 2.72; 5.16); and EFA 61-100 (slight/no disturbance in function), OR 5.81 (95%CI: 4.47; 7.55). The online prognostic tool SPOON was evaluated in a usability study. Based on feedback from clinicians, the tool was further refined to enable extraction of data for prediction directly from medical records. CONCLUSIONS The objective of SPOON is to complement the planning of rehabilitation initiatives and inform discussions to determine if a percutaneous endoscopic gastrostomy (PEG) tube should be inserted. SPOON is being implemented locally, but external validation based on appropriate data modeling is warranted before further clinical implementation.
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Affiliation(s)
- Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15, 8450, Hammel, Denmark.
| | - Asger Roer Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15, 8450, Hammel, Denmark; University Research Clinic for Innovative Patient Pathways, Diagnostic Centre, Silkeborg, Denmark
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Tassone P, Wieser M, Givens A, Elliott Z, Philips R, Curry J, Barrette LX, Cannady S, Mahomva C, Lamarre E, Prendes B, Robillard K, Sweeny L. Factors Leading to Gastrostomy Tube and Tracheostomy Requirements in Patients Treated Initially With Radiotherapy and Salvaged With Surgery and Free Flap Reconstruction. Laryngoscope 2023; 133:2141-2147. [PMID: 36478360 DOI: 10.1002/lary.30514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/31/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free-flap reconstruction. Resection and reconstruction can impact function, leading to tube dependence. PRIMARY OBJECTIVE describe rates of tracheostomy and gastrostomy tube dependence after oropharyngeal resection and free flap after prior radiation. SECONDARY OBJECTIVE evaluate patient, tumor, and treatment factors associated with tube dependence. STUDY DESIGN Retrospective, multi-institutional cohort study. Patients treated from 2003 to 2020. Average follow-up 21.4 months. SETTING Five tertiary care centers. METHODS Consecutive cohort of patients undergoing resection and simultaneous free-flap reconstruction for oropharyngeal squamous cell carcinoma after head and neck radiation. PRIMARY OUTCOMES gastrostomy tube dependence and tracheostomy or tracheostoma 1 year after surgery. Univariable and multivariable logistic regression were performed to identify factors associated with dependence. RESULTS 89 patients underwent oropharyngectomy and free-flap reconstruction; 18 (20%) underwent total laryngectomy as part of tumor extirpation. After surgery, 51 patients (57%) lived 12 months. Among patients alive at 12 months, 22 (43%) were at least partially-dependent on gastrostomy tube, and 15 (29%) had either tracheostomy or tracheostoma. On multivariable analysis, extensive glossectomy (OR 16.6, 95% CI 1.83-389, p = 0.026) and total laryngectomy (OR 11.2, 95% CI 1.71-105, p = 0.018) were associated with long-term gastrostomy tube. No factors were associated with long-term tracheostomy on multivariable analysis. CONCLUSION Even among long-term survivors after salvage resection and free-flap reconstruction, rates of tube dependence are significant. This multi-institutional review is the largest such study to the date and may help inform shared decision-making. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2141-2147, 2023.
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Affiliation(s)
- Patrick Tassone
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri, Columbia, Missouri, USA
| | - Margaret Wieser
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri, Columbia, Missouri, USA
| | - Alyssa Givens
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Zachary Elliott
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ramez Philips
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Louis-Xavier Barrette
- Department of Otolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven Cannady
- Department of Otolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chenge Mahomva
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Eric Lamarre
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brandon Prendes
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Katelyn Robillard
- Department of Otolaryngology - Head & Neck Surgery, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Larissa Sweeny
- Department of Otolaryngology - Head & Neck Surgery, Louisiana State University, Baton Rouge, Louisiana, USA
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Yasuda T, Matsuda A, Arai H, Kakinuma D, Hagiwara N, Kawano Y, Minamimura K, Matsutani T, Watanabe M, Suzuki H, Yoshida H. Feeding gastrostomy and duodenostomy using the round ligament of the liver versus conventional feeding jejunostomy after esophagectomy: a meta-analysis. Dis Esophagus 2023; 36:doac105. [PMID: 36607133 DOI: 10.1093/dote/doac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023]
Abstract
Esophageal cancer patients require enteral nutritional support after esophagectomy. Conventional feeding enterostomy to the jejunum (FJ) is occasionally associated with small bowel obstruction because the jejunum is fixed to the abdominal wall. Feeding through an enteral feeding tube inserted through the reconstructed gastric tube (FG) or the duodenum (FD) using the round ligament of the liver have been suggested as alternatives. This meta-analysis aimed to compare short-term outcomes between FG/FD and FJ. Studies published prior to May 2022 that compared FG or FD with FJ in cancer patients who underwent esophagectomy were identified via electronic literature search. Meta-analysis was performed using the Mantel-Haenszel random-effects model to calculate Odds Ratios (ORs) with 95% confidence intervals (CIs). Five studies met inclusion criteria to yield a total of 1687 patients. Compared with the FJ group, the odds of small bowel obstruction (OR 0.09; 95% CI, 0.02-0.33), catheter site infection (OR 0.18; 95% CI, 0.06-0.51) and anastomotic leakage (OR 0.53; 95% CI, 0.32-0.89) were lower for the FG/FD group. Odds of pneumonia, recurrent laryngeal nerve palsy, chylothorax and hospital mortality did not significantly differ between the groups. The length of hospital stay was shorter for the FG/FD group (median difference, -10.83; 95% CI, -18.55 to -3.11). FG and FD using the round ligament of the liver were associated with lower odds of small bowel obstruction, catheter site infection and anastomotic leakage than FJ in esophageal cancer patients who underwent esophagectomy.
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Affiliation(s)
- Tomohiko Yasuda
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Hiroki Arai
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Daisuke Kakinuma
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobutoshi Hagiwara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Youichi Kawano
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Keisuke Minamimura
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Takeshi Matsutani
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki-shi, Kanagawa Japan
| | - Masanori Watanabe
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Hideyuki Suzuki
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
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Haughey BS, Dean P, Spaeder MC, Smith CJ, Conaway M, White SC. Gastrostomy tube placement in congenital cardiac surgery: a multi-institutional database study. Cardiol Young 2023; 33:1672-1677. [PMID: 36184837 DOI: 10.1017/s1047951122003079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Neonates and infants who undergo congenital cardiac surgery frequently have difficulty with feeding. The factors that predispose these patients to require a gastrostomy tube have not been well defined. We aimed to report the incidence and describe hospital outcomes and characteristics in neonates and infants undergoing congenital cardiac surgery who required gastrostomy tube placement. MATERIALS AND METHOD A retrospective review was performed on patients undergoing congenital cardiac surgery between October 2015 and December 2020. Patients were identified by International Classification of Diseases 10th Revision codes, utilising the performance improvement database Vizient® Clinical Data Base, and stratified by age at admission: neonates (<1 month) and infants (1-12 months). Outcomes were compared and comparative analysis performed between admissions with and without gastrostomy tube placement. RESULTS There were 11,793 admissions, 3519 (29.8%) neonates and 8274 (70.2%) infants. We found an increased incidence of gastrostomy tube placement in neonates as compared to infants following congenital cardiac surgery (23.1% versus 6%, p = <0.001). Outcomes in neonates and infants were similar with increased length of stay and cost in those requiring a gastrostomy tube. Gastrostomy tube placement was noted to be more likely in neonates and infants with upper airway anomalies, congenital abnormalities, hospital infections, and genetic abnormalities. DISCUSSION Age at hospitalisation for congenital cardiac surgery is a definable risk factor for gastrostomy tube requirement. Additional factors contribute to gastrostomy tube placement and should be used when counselling families regarding the potential requirement of a gastrostomy tube.
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Affiliation(s)
- Brena S Haughey
- Department of Pediatrics (Cardiology), University of Virginia, Charlottesville, VA, USA
| | - Peter Dean
- Department of Pediatrics (Cardiology), University of Virginia, Charlottesville, VA, USA
| | - Michael C Spaeder
- Department of Pediatrics (Critical Care), University of Virginia, Charlottesville, VA, USA
| | - Clyde J Smith
- Department of Pediatrics (Cardiology), University of Virginia, Charlottesville, VA, USA
- Department of Pediatrics (Critical Care), University of Virginia, Charlottesville, VA, USA
| | - Mark Conaway
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Shelby C White
- Department of Pediatrics (Cardiology), University of Virginia, Charlottesville, VA, USA
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Collins GL, Hargis-Villanueva AE, Jayaraman MS, Lai K, Weidler EM, Griffiths PS, Rhee EK, Jorgensen S, Youssfi M, van Leeuwen K. A Prospective Management Strategy for Heterotaxy Syndrome with Intestinal Rotation Abnormalities: Imaging Does Not Predict Need for Surgery. J Pediatr Surg 2023; 58:1838-1842. [PMID: 36740478 DOI: 10.1016/j.jpedsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023]
Abstract
PURPOSE Heterotaxy syndrome (HS) affects right-left anatomical development in 3% of children with congenital heart disease. Commonly, these patients have intestinal rotation abnormalities (IRA) that differ from typical malrotation. In this prospective study, we examine the development of a management pathway, imaging findings, and clinical course of patients with HS and IRA. METHODS After literature review, a multispecialty focus group designed a pathway for HS. Participants from a single institution were prospectively enrolled from 2016 to 2019. They underwent an abdominal ultrasound and UGI, however timing was variable based on symptoms. Symptomatic IRA was defined as feeding intolerance, bilious or non-bilious vomiting, bloating, severe reflux, and intermittent pain or abdominal distention. Screening for symptoms occurred every three months for the first two years and then annually. RESULTS 18 participants were followed for a median of 5.0 years. Three clinical categories were identified: 1) asymptomatic, not requiring intestinal surgery, 72.2%, 2) symptomatic with feeding intolerance or failure to thrive requiring gastrostomy placement and diagnostic laparoscopy with Ladd procedure, 16.7%, and 3) symptomatic requiring urgent exploration for suspicion of volvulus, 11.1%. Need for surgery did not necessarily correlate with US and/or UGI findings. CONCLUSIONS In children with HS and IRA, postnatal imaging did not inform the need for intestinal surgery. Although rare, volvulus or other forms of proximal obstruction can be anticipated, and symptomatic patients should be offered surgical intervention. A multidisciplinary care pathway for patients with HS and IRA can coordinate care and help counsel families on the likelihood of needing intestinal surgery for IRA. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Prospective Cohort Study.
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Affiliation(s)
- Grant L Collins
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Angela E Hargis-Villanueva
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Meghna S Jayaraman
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Krista Lai
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Erica M Weidler
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Pamela S Griffiths
- Division of Neonatology, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Edward K Rhee
- Division of Cardiology, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Scott Jorgensen
- Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Mostafa Youssfi
- Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd., Phoenix, AZ, 85016, USA.
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Kotch C, Elgarten CW, McWhorter J, Schmus C, Wilhelm D, Li Y, Minturn JE. The Impact of Proactive Gastrostomy Tube Placement on Treatment-related Outcomes in Young Children With High-grade Central Nervous System Tumors. J Pediatr Hematol Oncol 2023; 45:333-338. [PMID: 37314947 DOI: 10.1097/mph.0000000000002694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023]
Abstract
Young children undergoing treatment with intensive chemotherapy for high-grade central nervous system (CNS) tumors are at risk for malnutrition, yet no guidelines exist for the placement of enteral tubes. Prior studies evaluated the impact of proactive gastrostomy tube (GT) placement with a narrow scope of outcomes, such as weight. To examine the impact of proactive GT on comprehensive treatment outcomes, we performed a single-center, retrospective study of children younger than 60 months of age with high-grade CNS tumors treated per CCG99703 or ACNS0334 between 2015 and 2022. Of 26 patients included, 9 (35%) underwent proactive GT, 8 (30%) had rescue GT, and 9 (35%) had a nasogastric tube (NGT). Clinically significant weight loss occurred in 47% of patients with NGT during induction compared with 22% with proactive GT ( P = 0.274); however, between cohorts, there was no significant difference in antibiotic or parenteral nutrition utilization, weight loss at therapy completion, and duration of hospitalization. Therefore, proactive GT placement was modestly effective at preventing significant weight loss during induction, however, there was no clear benefit for hospitalization duration, antibiotic, or parental nutrition requirements compared with NGT. We recommend an individualized approach to GT placement for young children with CNS malignancies undergoing intensive chemotherapy.
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Affiliation(s)
- Chelsea Kotch
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
| | - Caitlin W Elgarten
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
| | - Jessica McWhorter
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
| | - Cynthia Schmus
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- University of Pennsylvania School of Nursing
| | - Darielle Wilhelm
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
| | - Yimei Li
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Jane E Minturn
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
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Colletier K, Toy G, Freeman R, Dixon R, Morris J, Sossenheimer M, Fang J. Safety and efficacy of direct percutaneous endoscopic jejunostomy placement in patients with previous upper gastrointestinal resection: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2023; 47:796-801. [PMID: 37291075 DOI: 10.1002/jpen.2531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Percutaneous jejunal enteral access can be obtained with percutaneous endoscopic gastric jejunostomy (PEGJ) and direct percutaneous endoscopic jejunostomy (DPEJ) tubes. PEGJ may not be feasible in patients with previous gastric resection (PGR) and DPEJ may be the only option. Our aim is to determine if DPEJ tubes can be placed successfully in patients with history of gastrointestinal (GI) surgery and if success rates are comparable to DPEJ or PEGJ in those without prior GI surgery. METHODS We reviewed all tube placements performed from 2010 to present. Procedures were performed using a pediatric colonoscope. Previous upper GI surgery was defined as PGR or esophagectomy with gastric pull-up. Adverse events (AEs) were graded per American Society for Gastrointestinal Endoscopy criteria. Mild events included unplanned medical consultation or hospitalization <3 days, and moderate events included repeat endoscopy without surgical intervention. RESULTS Successful placement rates were high regardless of GI surgical history. Patients receiving a DPEJ with a history of GI surgery were significantly less likely to experience an AE compared with those receiving DPEJ with no history and compared with PEGJ patients with or without a history. CONCLUSIONS DPEJ placement in patients with previous upper GI surgery has very high success rate. It is associated with lower AE rates than patients receiving DPEJ without previous gastric surgery, or PEGJ regardless of previous gastric surgery. Patients with a history of upper GI surgery requiring enteral access may benefit from DPEJ over PEGJ placement considering its very high success rate and lower incidence of AEs.
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Affiliation(s)
- Keegan Colletier
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Greg Toy
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Freeman
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robert Dixon
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
- Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - John Morris
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | | | - John Fang
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
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50
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An unexpected percutaneous gastro-jejunostomy obstruction. J Paediatr Child Health 2023; 59:931. [PMID: 37417647 DOI: 10.1111/jpc.1_16141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 07/08/2023]
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