title: Feeding after percutaneous endoscopic gastrostomy: experience of early versus delayed feeding.
abstract: BACKGROUND
  Multiple studies have demonstrated that feeding ≤4 hours after placement of a percutaneous endoscopic gastrostomy (PEG) tube is a reasonable option. Many physicians, however, continue to delay feedings until the next day or 24 hours; therefore, we evaluated the safety and effect of early feeding (≤4 hours) after PEG placement in our tertiary care center.
  
  
  METHODS
  A retrospective study of 444 patients who underwent PEG between June 2006 and December 2011 was performed. Early feeding was defined as feeding ≤4 hours and delayed feeding was defined as feeding >4 hours. Statistical analysis was performed using the Fisher exact test and the Student t test.
  
  
  RESULTS
  A total of 444 patients underwent PEG between June 2006 and December 2011. A majority of PEGs were performed on inpatients by gastroenterologists. The mean time of feeding after PEG was 3.2 ± 0.9 hours for the early group (n = 197) and 17.0 ± 10.0 hours for the delayed group (n = 247). No statistically significant differences were noted between the early (≤4 hours) feedings versus the delayed (>4 hours) feedings for overall morality within 30 days (P = 0.72) and overall complications (P = 1.00). Furthermore, no statistically significant differences were noted between early versus delayed feeding for 24-hour mortality (P = 1.00), 24- to 72-hour mortality (P = 0.20), and 3-30 days mortality (P = 0.86). For each complication, there were no statistically significant differences noted between the two groups for wound infection (P = 0.52), melena (P = 0.26), vomiting (P = 0.42), leakage (P = 0.41), stomatitis (P = 0.13), aspiration pneumonia (P =1.00), and other complications (P = 0.47).
  
  
  CONCLUSIONS
  Feeding ≤4 hours after PEG appears to be as safe as delayed feeding. Based on this study and the literature, strong consideration for the majority of patients should be undertaken to begin feeding within 4 hours after PEG.
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: William J
authors.initials: WJ
authors.lastname: Cobell
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Alisha M
authors.initials: AM
authors.lastname: Hinds
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Rahul
authors.initials: R
authors.lastname: Nayani
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Syed
authors.initials: S
authors.lastname: Akbar
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Roxanne G
authors.initials: RG
authors.lastname: Lim
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Shoba
authors.initials: S
authors.lastname: Theivanayagam
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Matteson-Kome
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Choudhary
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
authors.affiliation: From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
mesh_terms: D000368:Aged; D015992:Body Mass Index; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy; D005774:Gastrostomy / Q000379:methods / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome