Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy.
OBJECTIVE
To investigate and predict enteral nutrition problems after percutaneous endoscopic gastrostomy (PEG).


METHODS
We retrospectively analyzed data for 252 out of 285 patients who underwent PEG at our hospital from 1999 to 2008. Enteral nutrition problems after PEG were defined as: (1) patients who required > or = 1 mo after surgery to switch to complete enteral nutrition, or who required additional parenteral alimentation continuously; or (2) patients who abandoned switching to enteral nutrition using the gastrostoma and employed other nutritional methods. We attempted to identify the predictors of problem cases by using a logistic regression analysis that examined the patients' backgrounds and the specific causes that led to their problems.


RESULTS
Mean age of the patients was 75 years, and in general, their body weight was low and their overall condition was markedly poor. Blood testing revealed that patients tended to be anemic and malnourished. A total of 44 patients (17.5%) were diagnosed as having enteral nutrition problems after PEG. Major causes of the problems included pneumonia, acute enterocolitis (often Clostridium difficile-related), paralytic ileus and biliary tract infection. A multivariate analysis identified the following independent predictors for problem cases: (1) enteral nutrition before gastrectomy (a risk reduction factor); (2) presence of esophageal hiatal hernia; (3) past history of paralytic ileus; and (4) presence of chronic renal dysfunction.


CONCLUSIONS
Enteral nutrition problems after PEG occurred at a comparatively high rate. Patient background analysis elucidated four predictive factors for the problem cases.
Yokohama
Shiro
S
Department of Gastroenterology, Asahikawa Rehabilitation Hospital, Midorigaoka Higashi 1-1-1-1, Asahikawa 078-8801, Japan. s44yokohama11@reha.or.jp
Aoshima
Masaru
M
Nakade
Yukiomi
Y
Shindo
Junya
J
Maruyama
Junichi
J
Yoneda
Masashi
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D004760:Enterocolitis / Q000453:epidemiology; D005260:Female; D005743:Gastrectomy; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000453:epidemiology; D007441:Intubation, Gastrointestinal / Q000379:methods; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D010288:Parenteral Nutrition; D011015:Pneumonia, Aspiration / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D002097:C-Reactive Protein