Nutritional status improvement in neurologically impaired patients by percutaneous endoscopic gastrostomy feeding.
With increased use of percutaneous endoscopic gastrostomy, it became clear that neurologically impaired patients might benefit from its use. From August 1996 to July 1997, we performed 19 percutaneous endoscopic gastrostomies in patients with neurological sequelae, who were incapable to maintain their nutritional status by oral ingestion or had repeated episodes of aspiration. Sixteen patients were followed prospectively, from 30 days to 11 months (median: 6.4 months). Average weight (38.2 kg to 44.8 kg), BMI (14.8 kg/m2 to 17.8 kg/m2), weight/height ratio (23.5 kg/cm to 28 kg/cm), mid-upper arm circumference (19.4 cm to 21.6 cm) and triceps skinfold thickness (10.3 mm to 12.6 mm) were significantly increased (P < 0.01). Before percutaneous endoscopic gastrostomy, there were 10 (10/16, 62.5%) patients with grade III thinness. In this group, 3/10 patients (30%) showed improvement to grade I (two individuals) and II (one patient). All but five patients (68.75%) were below the fifth percentile of normal distribution for mid-upper arm circumference. One patient (6.2%) showed improvement of her status (between 25th and 50th percentiles). Four patients (25%) started the follow-up below the fifth percentile for normal distribution of triceps skinfold thickness, and showed no improvement. There were no early complications secondary the procedure. Late complications included granulation tissue on ostomy site (18.8%) and ostomy infection (6.2%). Statistical analysis showed significant improvement of anthropometric data. Percutaneous endoscopic gastrostomy is a simple, highly successful and safe procedure, when performed in neurologically impaired patients. It is efficient as a long-term enteral feeding method.
Nakao
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Gastroenterology Department, Federal University of São Paulo Medical School, UNIFESP, Brasil.
Brant
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Stanich
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Ferrari Júnior
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AP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000886:Anthropometry; D002493:Central Nervous System Diseases / Q000150:complications*; D004750:Enteral Nutrition / Q000379:methods*; D005774:Gastrostomy; D006801:Humans; D008875:Middle Aged; D009748:Nutrition Disorders / Q000209:etiology / Q000628:therapy*; D009752:Nutritional Status; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors