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P225 COMPLICATIONS OF TUBE FEEDING (TF) ACCORDING TO THE ENTERAL ACCESS
120
Poster presentations
Results: The results of the experiment have been presented in a form of percentage of the containing globules of a certain size that are present in the TPN (see table). Under the mentioned conditions, the most numerous particles have been the ones of a size 1 2 mm. This satisfy the rule of pharmacopoeia that particle size of parenteral emulsion must be smaller than 5 mm. Conclusion: The results of our study confirmed that a TPN admixture prepared in a hospital pharmacy can be stored without stability loss at least 48 hours. We conclude that developing of the pharmaceutical scientific basis and knowledge concerned this form of therapy is constantly increasing. Disclosure of Interest: None declared.
P225 COMPLICATIONS OF TUBE FEEDING (TF) ACCORDING TO THE ENTERAL ACCESS A. Prieto1 , V. Rios1 , P. Cao1 , E. Camarero1 . 1 Nutrition Unit. Endocrinology and Nutrition Service. Department of Medicine, University Hospital of Santiago. SERGAS.USC, Santiago de Compostela, Spain Rationale: TF in home enteral nutrition (HEN), is usually provided via nasogastric (NG) or gastrostomy (GS) tubes. Although most patients need TF for more than 4 weeks, many of them leave the hospital with NG due to difficulties or rejection of the GS proceeding. Our aim is to study the relationship between enteral access, complications of TFand patients characteristics. Methods: All patients with HEN and TF seen in the nutrition team for 2 years were included. We study 4 complication groups: DIGESTIVE (DC): constipation, diarrhea, nausea/vomiting, regurgitation, bloating. MECHANICAL (MC): tube migration, granulation tissue, leakage of gastric content, stoma infection, others. METABOLIC (MBC) and RESPIRATORY (RC). Results: 304 patients were reviewed, 233 (76.6%) with NG and 71 (23.3%) with GS, 57.2% men, aged 74.5 y±16.3 (mean±SD). Characteristics (NG vs GS): 52.4% vs 73.2% men aged 78.37 y vs 61.76 y. Main diagnosis: Neurologic (79.5% vs 52.7%) and oncologic (16.4% vs43.6%) Complications: 55.6% of patients had any complication, mostly digestive (42.1%) and mechanical (15.8%). No patient needed hospital admission or stop TF due to complications. Table: Main complications: NG vs GS
COMPLICATIONS* n (%) DC n (%) Constipation n (%) MC* n (%) Tube migration n (%) MBC n (%) Dehydration n (%) RC n (%)
NG
GS
117 (50.2) 97 (41.6) 41 (17.2) 21 (9) 17 (7.3) 14 (5.6) 12 (5.2) 7 (3)
52 (73.2) 32 (42.6) 16 (22.5) 27 (38) 14 (19.7) 2 (2.8) 2 (2.8) 4 (5.6)
*p 0.001, n: number of patients, (%): percentage of patients.
Conclusion: In our patients with HEN, NG is the main access, mostly in older patients with neurologic diseases.
Constipation is the most frequent complication in both groups, but total complications and MC are significantly more frequent with GS than with NG. The risk of pneumonia due to bronchoaspiration is low and similar with NG or GS. TF via NG or GS is useful and safe when managed by an expert team. Disclosure of Interest: None declared.
P226 Outstanding abstract SAFETY OF BOLUS GASTROSTOMY TUBE FEEDING USING ADJUSTED HIGH-VISCOSITY OF SEMI-SOLID DIETS F. Goda1 , M. Inukai1 , H. Okuyama2 , T. Himoto2 , H. Masugata2 , S. Senda2 . 1 Cancer Center, 2 Integrated Medicine, Kagawa University Hospital, Kagawa, Japan Rationale: Why do we use liquid diets for gastrostomy tube feeding? Meal induced adaptive relaxations of the stomach are reflex responses that enable the stomach to accommodate large volumes with minimal increases in intraluminal pressure. However, a slow rate liquid feeding, which dose not extend the stomach due to the lack of volume and viscosity of diets, can cause impaired gastric accommodation and abnormal gastric emptying including gastro-esophageal reflux. We investigated the effect of viscosity of diets on physiological gastric peristalsis and gastro-esophageal reflux using various viscosities of barium and X-ray. Methods: Bolus gastrostomy tube feeding was employed. Three healthy volunteers and 22 gastrostomy patients participated. The subjects received 400 ml of barium of different viscosities after 6-hour fasting with a 1-week interval. X-ray video and images were obtained before and 5, 15, 30, 60, 90 and 120 minutes after barium infusion. Results: Maximum gastric peristalsis were observed 10 30 minutes after intake of high-viscosity of barium. For patients, high-viscosity barium had sufficient accommodation and the barium moved slowly toward to the duodenum following gastric peristalsis, whereas low-viscosity barium showed poor accommodation and barium moved rapidly in all directions in the stomach without regulating gastric peristalsis, resulting in gastricesophageal reflux. The incidence of gastric-esophageal reflux is independent of the residual volume of barium when the viscosity was different. Using 50,000 cP, there was no gastric-esophageal reflux but it was hard to ingest. One of 15 cases refluxed at 20,000 cP and 6 of 15 cases refluxed using the intermittent method. Conclusion: Our results indicate that bolus gastrostomy tube feeding can be performed safely with adjusted highviscosity of diets. Using high-viscosity diets, physiological gastric accommodation and emptying can be expected. Disclosure of Interest: F. Goda, Japan Society for the Promotion of Science (JSPS), Grant Research Support; Japanese Society for Parental and Enteral Nutrition (JSPEN), Grant Research Support.
Poster presentations
Results: The results of the experiment have been presented in a form of percentage of the containing globules of a certain size that are present in the TPN (see table). Under the mentioned conditions, the most numerous particles have been the ones of a size 1 2 mm. This satisfy the rule of pharmacopoeia that particle size of parenteral emulsion must be smaller than 5 mm. Conclusion: The results of our study confirmed that a TPN admixture prepared in a hospital pharmacy can be stored without stability loss at least 48 hours. We conclude that developing of the pharmaceutical scientific basis and knowledge concerned this form of therapy is constantly increasing. Disclosure of Interest: None declared.
P225 COMPLICATIONS OF TUBE FEEDING (TF) ACCORDING TO THE ENTERAL ACCESS A. Prieto1 , V. Rios1 , P. Cao1 , E. Camarero1 . 1 Nutrition Unit. Endocrinology and Nutrition Service. Department of Medicine, University Hospital of Santiago. SERGAS.USC, Santiago de Compostela, Spain Rationale: TF in home enteral nutrition (HEN), is usually provided via nasogastric (NG) or gastrostomy (GS) tubes. Although most patients need TF for more than 4 weeks, many of them leave the hospital with NG due to difficulties or rejection of the GS proceeding. Our aim is to study the relationship between enteral access, complications of TFand patients characteristics. Methods: All patients with HEN and TF seen in the nutrition team for 2 years were included. We study 4 complication groups: DIGESTIVE (DC): constipation, diarrhea, nausea/vomiting, regurgitation, bloating. MECHANICAL (MC): tube migration, granulation tissue, leakage of gastric content, stoma infection, others. METABOLIC (MBC) and RESPIRATORY (RC). Results: 304 patients were reviewed, 233 (76.6%) with NG and 71 (23.3%) with GS, 57.2% men, aged 74.5 y±16.3 (mean±SD). Characteristics (NG vs GS): 52.4% vs 73.2% men aged 78.37 y vs 61.76 y. Main diagnosis: Neurologic (79.5% vs 52.7%) and oncologic (16.4% vs43.6%) Complications: 55.6% of patients had any complication, mostly digestive (42.1%) and mechanical (15.8%). No patient needed hospital admission or stop TF due to complications. Table: Main complications: NG vs GS
COMPLICATIONS* n (%) DC n (%) Constipation n (%) MC* n (%) Tube migration n (%) MBC n (%) Dehydration n (%) RC n (%)
NG
GS
117 (50.2) 97 (41.6) 41 (17.2) 21 (9) 17 (7.3) 14 (5.6) 12 (5.2) 7 (3)
52 (73.2) 32 (42.6) 16 (22.5) 27 (38) 14 (19.7) 2 (2.8) 2 (2.8) 4 (5.6)
*p 0.001, n: number of patients, (%): percentage of patients.
Conclusion: In our patients with HEN, NG is the main access, mostly in older patients with neurologic diseases.
Constipation is the most frequent complication in both groups, but total complications and MC are significantly more frequent with GS than with NG. The risk of pneumonia due to bronchoaspiration is low and similar with NG or GS. TF via NG or GS is useful and safe when managed by an expert team. Disclosure of Interest: None declared.
P226 Outstanding abstract SAFETY OF BOLUS GASTROSTOMY TUBE FEEDING USING ADJUSTED HIGH-VISCOSITY OF SEMI-SOLID DIETS F. Goda1 , M. Inukai1 , H. Okuyama2 , T. Himoto2 , H. Masugata2 , S. Senda2 . 1 Cancer Center, 2 Integrated Medicine, Kagawa University Hospital, Kagawa, Japan Rationale: Why do we use liquid diets for gastrostomy tube feeding? Meal induced adaptive relaxations of the stomach are reflex responses that enable the stomach to accommodate large volumes with minimal increases in intraluminal pressure. However, a slow rate liquid feeding, which dose not extend the stomach due to the lack of volume and viscosity of diets, can cause impaired gastric accommodation and abnormal gastric emptying including gastro-esophageal reflux. We investigated the effect of viscosity of diets on physiological gastric peristalsis and gastro-esophageal reflux using various viscosities of barium and X-ray. Methods: Bolus gastrostomy tube feeding was employed. Three healthy volunteers and 22 gastrostomy patients participated. The subjects received 400 ml of barium of different viscosities after 6-hour fasting with a 1-week interval. X-ray video and images were obtained before and 5, 15, 30, 60, 90 and 120 minutes after barium infusion. Results: Maximum gastric peristalsis were observed 10 30 minutes after intake of high-viscosity of barium. For patients, high-viscosity barium had sufficient accommodation and the barium moved slowly toward to the duodenum following gastric peristalsis, whereas low-viscosity barium showed poor accommodation and barium moved rapidly in all directions in the stomach without regulating gastric peristalsis, resulting in gastricesophageal reflux. The incidence of gastric-esophageal reflux is independent of the residual volume of barium when the viscosity was different. Using 50,000 cP, there was no gastric-esophageal reflux but it was hard to ingest. One of 15 cases refluxed at 20,000 cP and 6 of 15 cases refluxed using the intermittent method. Conclusion: Our results indicate that bolus gastrostomy tube feeding can be performed safely with adjusted highviscosity of diets. Using high-viscosity diets, physiological gastric accommodation and emptying can be expected. Disclosure of Interest: F. Goda, Japan Society for the Promotion of Science (JSPS), Grant Research Support; Japanese Society for Parental and Enteral Nutrition (JSPEN), Grant Research Support.