Brief Articles
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World J Gastroenterol. Mar 21, 2009; 15(11): 1367-1372
Published online Mar 21, 2009. doi: 10.3748/wjg.15.1367
Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy
Shiro Yokohama, Masaru Aoshima, Yukiomi Nakade, Junya Shindo, Junichi Maruyama, Masashi Yoneda
Shiro Yokohama, Masaru Aoshima, Department of Gastroenterology, Asahikawa Rehabilitation Hospital, Asahikawa 078-8801, Japan
Junya Shindo, Department of Rehabilitation, Asahikawa Rehabilitation Hospital, Asahikawa 078-8801, Japan
Junichi Maruyama, Department of Internal Medicine, Asahikawa Rehabilitation Hospital, Asahikawa 078-8801, Japan
Yukiomi Nakade, Masashi Yoneda, Division of Gastro-enterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi 480-1195, Japan
Author contributions: Yokohama S performed the majority of research; Yokohama S and Aoshima M designed research; Yokohama S, Shindo J and Maruyama J analyzed data; Yokohama S, Nakade Y and Yoneda M wrote the paper.
Correspondence to: Dr. Shiro Yokohama, Department of Gastroenterology, Asahikawa Rehabilitation Hospital, Midorigaoka Higashi 1-1-1-1, Asahikawa 078-8801, Japan. s44yokohama11@reha.or.jp
Telephone: +81-166-650101
Fax: +81-166-682459
Received: December 24, 2008
Revised: January 22, 2009
Accepted: January 29, 2009
Published online: March 21, 2009
Abstract

AIM: 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 ≥ 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.

CONCLUSION: Enteral nutrition problems after PEG occurred at a comparatively high rate. Patient background analysis elucidated four predictive factors for the problem cases.

Keywords: Percutaneous endoscopic gastrostomy; Enteral nutrition; Complication, Risk factor; Predictor