title: Pump-assisted versus gravity-controlled enteral nutrition in long-term percutaneous endoscopic gastrostomy patients: a prospective controlled trial.
abstract: BACKGROUND
  Vomiting, aspiration, flatulence, and diarrhea are well-known negative side effects of enteral nutrition through percutaneous endoscopic gastrostomy (PEG). However, it is not yet clarified if pump-assisted (PA) or gravity-controlled (GC) application is the more comfortable and safe choice for long-term nutrition through PEG.
  
  
  METHODS
  This was a prospective, randomized, crossover study. Fifty long-term PEG patients were fed by PA nutrition (G1) and 50 patients were fed by GC nutrition (G2). Six weeks of observation (O1) was followed by a switch of method of nutritional application in both groups and an additional 6 weeks of observation (O2). Daily determination of comfort and safety was done with a standardized questionnaire. Evaluation of blood glucose levels on days 1, 21, and 42 during O1 and O2.
  
  
  RESULTS
  The patients in both groups had the same medical conditions and were of the same age and sex. Far less flatulence (p < .0006) and epigastric fullness (p < .0003) was discovered in G1 during O1. Also, significantly less regurgitation (p < .0002) and vomiting of feeding diet (p < .0001) in G1 versus G2 could be observed. The rate of diarrhea (p < .0003) in G2 was higher than in G1. The daily profile of blood glucose was significantly better (p < .0008) in G1 than in G2. After the nutritional application was changed in O2, the PA group (G2) again showed a significantly better rate of flatulence, epigastric fullness, regurgitation, vomiting, diarrhea, and daily profile of blood glucose. Ninety-six percent of the patients in G2 preferred further nutrition by PA after finishing this study. All patients in G1 continued their accustomed nutrition by PA.
  
  
  CONCLUSIONS
  Nutrition through PA showed not only a higher comfort rate but also increased safety, which was expressed through a low rate of regurgitation and vomiting. PA presented better glucose metabolization manifested in improved blood glucose levels. As a result of this prospective study, PA is preferable to GC and preferred by patients with long-term PEG nutrition.
authors.affiliation: Department of Surgery, University Hospital Mannheim, Germany. Edward.shang@urz.uni-heidelberg.de
authors.forename: Edward
authors.initials: E
authors.lastname: Shang
authors.forename: Nicole
authors.initials: N
authors.lastname: Geiger
authors.forename: Joerg W
authors.initials: JW
authors.lastname: Sturm
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003967:Diarrhea / Q000209:etiology; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D005260:Female; D005414:Flatulence / Q000209:etiology; D005774:Gastrostomy; D006112:Gravitation; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014839:Vomiting / Q000209:etiology