[Start of enteral nutrition after an endoscopic gastrostomy, is it necessary to wait?]

Area of Science:

• Clinical Nutrition
• Gastroenterology
• Surgical Outcomes

Background:

• Enteral nutrition (EN) initiation post-percutaneous endoscopic gastrostomy (PEG) typically occurs 12-24 hours after the procedure.
• Emerging evidence suggests that earlier EN initiation may be safe and beneficial.
• Optimizing the timing of EN initiation post-PEG is crucial for patient recovery and resource utilization.

Purpose of the Study:

• To evaluate the safety and feasibility of initiating EN 4 hours post-PEG compared to the standard 12-hour interval.
• To assess differences in nutritional intolerance, postoperative complications, and mortality between early and standard EN initiation groups.
• To provide evidence-based recommendations for optimizing EN timing after PEG placement.

Main Methods:

• Prospective, randomized, multicenter study conducted in Bogotá and Cundinamarca from June 2020 to May 2022.
• 117 patients undergoing PEG were randomized into two groups: early EN initiation (4 hours) and standard EN initiation (12 hours).
• Data collected included causes of dysphagia (cerebrovascular disease, COVID-19 complications), nutritional intolerance, postoperative complications, and mortality.

Main Results:

• No statistically significant differences were observed in the incidence of nutritional intolerance between the early (4-hour) and standard (12-hour) EN initiation groups (RR = 0.93; 95% CI: 0.30-2.90).
• Postoperative complications (RR = 0.34; 95% CI: 0.09-1.16) and mortality (RR = 1.12; 95% CI: 0.59-2.15) did not differ significantly between the two groups.
• Cerebrovascular disease (43%) and COVID-19 complications (26%) were the primary indications for PEG and dysphagia.

Conclusions:

• Early initiation of EN 4 hours after PEG placement is a safe practice.
• This early feeding approach does not lead to increased nutritional intolerance, complications, or mortality compared to the traditional 12-hour interval.
• The findings support revising current guidelines to consider earlier EN initiation post-PEG.