A comparative observational study of early versus delayed feeding after percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice for long-term enteral feeding.

This prospective observational study was carried out to compare the safety of commencing feeding 3 h compared to 16-24 h after PEG tube placement.

One hundred and ten patients with oropharyngeal malignancies who had consented for PEG were enrolled. Trial-specific consent and IRB approval were not obtained because at the time when this study was done, this was not mandatory for observational studies which involved standard procedures. Alternate patients were started on early feeding within 3 h (group I) or after overnight observation of 16 to 24 h (group II). Five hundred milliliters of Ringer's lactate was infused over 4 h initially, followed 2 h later by 200 mL of formula feed. The patients were advised to take bolus feeds of 200 mL every 2 h and oral feeds ad libitum from the next day. All patients were evaluated on days 1, 2, 7, and 30.

There were 55 patients (47 males) in group I and 54 patients (38 males) in group II who were matched for age (mean age 46.1 and 46.1 years, respectively). Complications included PEG site infection (1), peristomal leak (3), and displacement of the PEG tube (1) in group I. PEG site infection was seen in five patients in group II. All the complications were managed conservatively on an ambulatory basis.

Initiation of tube feeding 3 h after an uncomplicated PEG was safe, well tolerated, and helped to reduce the hospital stay.