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Percutaneous endoscopic gastrostomy: a randomized prospective comparison of early and delayed feeding
U Choudhry1, C J Barde, R Markert
1Wright State University School of Medicine, Dayton, Ohio, USA.
Insights
Initiating percutaneous endoscopic gastrostomy (PEG) tube feeding 3 hours after placement is safe for elderly patients, similar to the traditional 24-hour wait. This early feeding approach is well-tolerated and effective.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Geriatric Medicine
Background:
- Traditionally, percutaneous endoscopic gastrostomy (PEG) tube feeding commenced 24 hours or more post-placement.
- Early hospital discharge initiatives necessitate re-evaluating established feeding protocols.
Purpose of the Study:
- To assess the safety and efficacy of initiating PEG tube feeding earlier (3 hours post-placement) compared to the conventional 24-hour interval.
- To evaluate the impact of early feeding on patient outcomes in a randomized prospective study.
Main Methods:
- Forty-one elderly patients were randomized into two groups: early feeding (3 hours) and conventional feeding (24 hours).
- Patients received an iso-osmolar formula via continuous infusion, with feeding rates adjusted based on tolerance and residual volumes.
- Clinical assessments, including vital signs and local site evaluation, were performed regularly for 72 hours post-procedure.
Main Results:
- One patient in the conventional feeding group died during the study period; no deaths were attributed to feeding protocols.
- A small number of patients experienced significant residual volumes or local skin infection, with no cases of peritonitis or systemic infection observed.
- Early PEG feeding demonstrated comparable safety outcomes to delayed feeding.
Conclusions:
- Initiating percutaneous endoscopic gastrostomy (PEG) tube feeding 3 hours after placement is a safe alternative to the standard 24-hour delay in elderly patients.
- Early feeding protocols may support earlier patient mobilization and hospital discharge without compromising safety.
Background:
It has been customary to initiate feeding through percutaneous endoscopic gastrostomy (PEG) tubes 24 hours or more after placement of these tubes. Recent changes in practice environment and emphasis on early discharge of hospitalized patients prompted us to evaluate early PEG feeding in a randomized prospective manner.
Methods:
Forty-one patients were included in the study. After an informed consent, the patients were randomly assigned to two groups. Groups I (21 patients) received tube feedings 3 hours and Group II (20 patients) received feedings 24 hours after PEG placement. All patients received an Iso-osmolar formula by continuous infusion at 30 ml/hour for the first 24 hours of feeding. The rates were then increased to 70 ml/hour. Residual volumes, tube length, peristomal leakage, and vital signs were checked, and a global assessment was done every 4 hours. Evaluation by a physician was done every 24 hours for 72 hours. If the residual volume was more than 60 ml (significant residual volume), the tube feedings were held for 2 hours. Patients exited the study at 72 hours from the time of procedure. All deaths were recorded to calculate 30-day mortality.
Results:
One patient (Group 2) died during the study period. Three patients (two in Group 1 and one in Group 2) had a significant residual volume. One patient (Group 1) had local skin infection requiring treatment. None of the patients had any signs of peritonitis or systemic infection.
Conclusion:
Early PEG tube feeding (3 hours after tube placement) is as safe as next day feeding in elderly patients.