Early feeding safe after percutaneous endoscopic gastrostomy tube placement
Click Here to Manage Email Alerts
CHARLOTTE, N.C. — Results of a systematic review and meta-analysis presented at the ACG Annual Scientific Meeting indicate that early feeding after percutaneous endoscopic gastrostomy tube placement is safe and may shorten hospital stay.
“Despite the common clinical practice of delaying feedings after [percutaneous endoscopic gastrostomy (PEG)] placement, early feeding appears to be safe and, if implemented in clinical practice, may result in decreased hospital length of stay and health care costs for those patients undergoing PEG placement,” study co-author Mahesh Gajendran, MD, MPH, of the University of Texas Health Science Center at San Antonio, told Healio.
According to Gajendran, PEG tubes have been used in clinical practice since 1980.
“Previous meta-analysis published in 2008 showed that it is safe to start tube feeding within 4 hours of PEG tube placement,” Gajendran said. “Despite many studies indicating that it is safe to initiate early PEG feeding, there is still a delay in postPEG feeding up to 24 hours after PEG tube placement.”
In June 2022, Gajendran and colleagues performed a database search for randomized controlled trials that compared early (4 hours) and delayed feeding (>4 hours) after PEG tube placement in adults. Researchers included seven trials with 507 patients in their analysis and considered complication and mortality rates within 72 hours of the procedure as primary study outcomes.
According to analysis, there was no difference in pooled complication rate (OR = 0.87; 95% CI, 0.52-1.46) and mortality rate (OR = 0.56; 95% CI, 0.19-1.74). However, the pooled OR for gastric residuals was 1.75 (95% CI, 0.99-3.09), with more gastric residuals in the early feeding group.
Researchers also found one study that indicated a significant decrease in the length of hospital stay with early feeding (27 vs. 33 hours).
“Future studies can study the effect of early vs. delayed feeding based on the different techniques of gastrostomy tube placement,” Gajendran said. “Also, we need more studies to determine the effect of high pre-feeding gastric residual volume after the PEG placement.”
Perspective
Back to Top
Shirley Paski, MD
Percutaneous endoscopic gastrostomy tubes are an important treatment for patients who have difficulty swallowing or are unable to meet their nutritional requirements orally. After an uncomplicated PEG or PEG-J tube placement, patients may start receiving medications through the tube immediately and may start tube feedings 4 hours after placement.
Starting tube feedings 4 hours post-PEG placement is safe, well-tolerated and reduces costs by decreasing hospital length of stay, as shown by multiple randomized trials done in the 1990s. It also is recommended in published society guidelines.
Collapse
Gajendran M, et al. Abstract 30. Early vs. delayed feeding after percutaneous endoscopic gastrostomy tube placement- systematic review and meta-analysis. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid).
Read more about
Click Here to Manage Email Alerts