title: Pump-assisted enteral nutrition can prevent aspiration in bedridden percutaneous endoscopic gastrostomy patients.
abstract: BACKGROUND
  Vomiting, aspiration, and pneumonia are serious side effects in enteral feeding via percutaneous endoscopic gastrostomy (PEG), which often leads to hospitalization. To this day, it has not been proven whether pump-assisted (PA) or gravity-controlled application is the safer method for long-term feeding via PEG in bedridden patients.
  
  
  METHODS
  This study was conducted as a prospective, randomized crossover study. Fifty bedridden PEG patients were fed using the pump-assisted method (G1) and 50 patients were fed using the gravity-controlled feeding method (G2). After 6 weeks of observation (O1), the feeding methods in both groups were switched, followed by another 6 weeks of observation (O2). Daily recording was done using a standardized questionnaire. The glucose levels during O1 and O2 were determined on days 1, 21, and 42.
  
  
  RESULTS
  The patients in both groups were compatible in age, sex, and medical illness. By comparing G1 and G2, a significantly lower regurgitation rate (p < .0002), vomiting of feeding substrate (p < .009), aspiration (p < .01), and pneumonia (p < .02) was observed. The diarrhea rate in G2 was higher than in G1 (p < .007). The glucose profiles in G1 showed a significantly better development (p < .0007) than the ones in G2. After switching the application method in G2, the PA group (now G2) showed a significantly improved rate of regurgitation, vomiting, aspiration, and diarrhea and improved glucose profiles.
  
  
  CONCLUSIONS
  Feeding via PA shows improved safety, which is documented in a lower rate of diarrhea, regurgitation, vomiting, and aspiration. PA also noted a more effective glucose metabolization, which results in better glucose levels. As a result of this prospective study, pump-assisted feeding is recommended for bedridden patients requiring long-term feeding via PEG.
authors.affiliation: University Hospital Mannheim, Department of Surgery, Theodor-Kutzer-Ufer 1-3, Mannheim 68135, 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: D000368:Aged; D019540:Area Under Curve; D001510:Bed Rest; D001786:Blood Glucose / Q000378:metabolism; D018592:Cross-Over Studies; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control; D004750:Enteral Nutrition / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005774:Gastrostomy; D005947:Glucose / Q000378:metabolism; D006112:Gravitation; D006801:Humans; D007260:Infusion Pumps; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012449:Safety; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014839:Vomiting / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D001786:Blood Glucose; D005947:Glucose