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Gastric and Enteral Access for Feeding in Critically Ill Patients

  • Non-Vascular Interventional Radiology (A Thabet, Section Editor)
  • Published:
Current Trauma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this study is to review recent advancements, trends, and recommendations in gastric and enteral feeding with a focus on critically ill patients.

Recent Findings

Enteral feeding continues to serve as the mainstay for nutritional support in critically ill patients and is favored over parenteral nutrition, though recent trials suggest no substantial difference in outcomes between the two methods. Radiologic and endoscopic guidance remain the most common methods for enteral access. Additionally, recent advancements in enteral access technique and trials on best practices for timing and composition of nutritional support in critically ill patients continue to reduce complications, improve outcomes, and reduce cost.

Summary

Nutritional support improves outcomes in critically ill patients, and the safe and durable establishment of enteral access is an important component in the care of these patients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Arabi YM, Aldawood AS, Haddad SH, et al. Permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med. 2015;372:2398–408.

    Article  CAS  Google Scholar 

  2. Martindale RG, McClave SA, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary. Crit Care Med. 2009;37:1757–61.

    Article  Google Scholar 

  3. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5–15.

    Article  Google Scholar 

  4. Harvey SE, Parrott F, Harrison DA, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371:1673–84.

    Article  Google Scholar 

  5. Elke G, van Zanten ARH, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;1–14.

  6. Seres DS, Valcarcel M, Guillaume A. Advantages of enteral nutrition over parenteral nutrition. Therap Adv Gastroenterol. 2013;6:157–67.

    Article  Google Scholar 

  7. Yarmus L, Gilbert C, Lechtzin N, Imad M, Ernst A, Feller-Kopman D. Safety and feasibility of interventional pulmonologists performing bedside percutaneous endoscopic gastrostomy tube placement. Chest. 2013;144:436–40.

    Article  Google Scholar 

  8. Gomes CAR, Andriolo RB, Bennett C, Lustosa SAS, Matos D, Waisberg DR, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev. 2015; CD008096.

  9. •• Alkhawaja S, Martin C, Butler RJ, Gwadry-Sridhar F. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. Cochrane Database Syst Rev. 2015; CD008875. Recent systematic review with meta-analysis evaluating outcomes from gastric versus post-pyloric feeding in critically ill patients. Outcomes measured included but not limited to mortality, ICU length of stay, and pneumonia.

  10. Adam MD, Rupinder D, Andrew GD, Emma JR, Andrew RD, Daren KH. Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis. Crit Care. 2013;17:R125.

    Article  Google Scholar 

  11. Silva CCRD, Bennett C, Saconato H, Atallah ÁN. Metoclopramide for post-pyloric placement of naso-enteral feeding tubes. Cochrane Database Syst Rev. 2015;1:CD003353.

    PubMed  Google Scholar 

  12. Itkin M, DeLegge MH, Fang JC, et al. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). J Vasc Interv Radiol. 2011;22:1089–106.

    Article  Google Scholar 

  13. Gerritsen A, van der Poel MJ, de Rooij T, Molenaar IQ, Bergman JJ, Busch OR, et al. Systematic review on bedside electromagnetic-guided, endoscopic, and fluoroscopic placement of nasoenteral feeding tubes. Gastrointest Endosc. 2015;81:836–47.e2.

    Article  Google Scholar 

  14. Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014;51:1427–33.

    Article  Google Scholar 

  15. Irving SY, Lyman B, Northington L, Bartlett JA, Kemper C, Novel Project Work Group. Nasogastric tube placement and verification in children: review of the current literature. Crit Care Nurse. 2014;34:67–78.

    Article  Google Scholar 

  16. Society of Pediatric Nurses (SPN) Clinical Practice Committee, SPN Research Committee, Longo MA. Best evidence: nasogastric tube placement verification. J Pediatr Nurs. 2011;26:373–6.

    Article  Google Scholar 

  17. Bennetzen LV, Håkonsen SJ, Svenningsen H, Larsen P. Diagnostic accuracy of methods used to verify nasogastric tube position in mechanically ventilated adult patients: a systematic review. JBI Database System Rev Implement Rep. 2015;13:188–223.

    Article  Google Scholar 

  18. Seder CW, Stockdale W, Hale L, Janczyk RJ. Nasal bridling decreases feeding tube dislodgment and may increase caloric intake in the surgical intensive care unit: a randomized, controlled trial. Crit Care Med. 2010;38:797–801.

    Article  Google Scholar 

  19. • Brugnolli A, Ambrosi E, Canzan F, Saiani L, Group1 N-GT. Securing of naso-gastric tubes in adult patients: a review. Int J Nurs Stud. 2014;51:943–50. A systematic review evaluating the most effective securing device for prevention of nasal gastric tube dislodgement.

    Article  CAS  Google Scholar 

  20. Stumpf JL, Kurian RM, Vuong J, Dang K, Kraft MD. Efficacy of a Creon delayed-release pancreatic enzyme protocol for clearing occluded enteral feeding tubes. Ann Pharmacother. 2014;48:483–487.

    Article  CAS  Google Scholar 

  21. • Bechtold ML, Mir FA, Boumitri C, Palmer LB, Evans DC, Kiraly LN, et al. Long-term nutrition: a clinician’s guide to successful long-term enteral access in adults. Nutr Clin Pract. 2016; doi:10.1177/0884533616670103. Comprehensive review article which summarizes and answers common questions related to long-term enteral access with an emphasis on endoscopic techniques. Topics visited include indications, complications, and maintenance.

    Article  Google Scholar 

  22. Onur OE, Onur E, Guneysel O, Akoglu H, Denizbasi A, Demir H. Endoscopic gastrostomy, nasojejunal and oral feeding comparison in aspiration pneumonia patients. J Res Med Sci. 2013;18:1097–102.

    PubMed  PubMed Central  Google Scholar 

  23. Fei JZ, DeMuro JP. Percutaneous endoscopic gastrostomy in the open abdomen patient. J Parenter Enter Nutr. 2013;37:695–6.

    Article  Google Scholar 

  24. Wyman EA, Nygaard RM, Richardson CJ, Quickel RR. Safety of percutaneous endoscopic gastrostomy after trauma laparotomy. J Surg Res. 2014;192:607–10.

    Article  Google Scholar 

  25. Oterdoom LH, Marinus Oterdoom DL, Ket JCF, van Dijk JMC, Scholten P. Systematic review of ventricular peritoneal shunt and percutaneous endoscopic gastrostomy: a safe combination. J Neurosurg. 2016;1–6.

  26. Cappell MS. Risk factors and risk reduction of malignant seeding of the percutaneous endoscopic gastrostomy track from pharyngoesophageal malignancy: a review of all 44 known reported cases. Am J Gastroenterol. 2007;102:1307–1311.

    Article  Google Scholar 

  27. Axelsson L, Silander E, Nyman J, Bove M, Johansson L, Hammerlid E. Effect of prophylactic percutaneous endoscopic gastrostomy tube on swallowing in advanced head and neck cancer: a randomized controlled study. Head Neck. 2017;51:787–8.

    Google Scholar 

  28. Fung E, Strosberg DS, Jones EL, Dettorre R, Suzo A, Meara MP, et al. Incidence of abdominal wall metastases following percutaneous endoscopic gastrostomy placement in patients with head and neck cancer. Surg Endosc. 2016;15:872.

    Google Scholar 

  29. Yuan Y, Zhao Y, Xie T, Hu Y. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev. 2016;2:CD009198.

    PubMed  Google Scholar 

  30. Haber ZM, Charles HW, Gross JS, Pflager D, Deipolyi AR. Percutaneous radiologically guided gastrostomy tube placement: comparison of antegrade transoral and retrograde transabdominal approaches. Diagn Interv Radiol. 2017;23:55–60.

    Article  Google Scholar 

  31. •• Sheth RA, Koottappillil B, Kambadakone A, Ganguli S, Thabet A, Mueller PR. A Quality improvement initiative to reduce catheter exchange rates for fluoroscopically guided gastrostomy tubes. J Vasc Interv Radiol. 2016;27:251–259. Identified procedural and patient risk-factors associated with PRG complications which were then implemented in a quality improvement study that resulted in fewer PRG exchanges.

    Article  Google Scholar 

  32. Busch JD, Herrmann J, Adam G, Habermann CR. Radiologically inserted gastrostomy: differences of maintenance of balloon- vs. loop-retained devices. Scand J Gastroenterol. 2016;51:1423–8.

    Article  CAS  Google Scholar 

  33. Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database Syst Rev. 2013;CD005571.

  34. Cantwell CP, Perumpillichira JJ, Maher MM, Hahn PF, Arellano R, Gervais DA, et al. Antibiotic prophylaxis for percutaneous radiologic gastrostomy and Gastrojejunostomy insertion in outpatients with head and neck cancer. J Vasc Interv Radiol. 2008;19:571–5.

    Article  Google Scholar 

  35. Thornton FJ, Fotheringham T, Haslam PJ, McGrath FP, Keeling F, Lee MJ. Percutaneous radiologic gastrostomy with and without T-fastener gastropexy: a randomized comparison study. Cardiovasc Intervent Radiol. 2002;25:467–71.

    Article  CAS  Google Scholar 

  36. Ridtitid W, Lehman GA, Watkins JL, McHenry L, Fogel EL, Sherman S, et al. Short- and long-term outcomes from percutaneous endoscopic gastrostomy with jejunal extension. Surg Endosc. 2016;80:34.

    Google Scholar 

  37. Uflacker A, Qiao Y, Easley G, Patrie J, Lambert D, de Lange EE. Fluoroscopy-guided jejunal extension tube placement through existing gastrostomy tubes: analysis of 391 procedures. Diagn Interv Radiol. 2015;21:488–93.

    Article  Google Scholar 

  38. Toh Yoon EW, Yoneda K, Nakamura S, Nishihara K. Percutaneous endoscopic transgastric jejunostomy (PEG-J): a retrospective analysis on its utility in maintaining enteral nutrition after unsuccessful gastric feeding. BMJ Open Gastroenterol. 2016;3:e000098.

    Article  Google Scholar 

  39. Kim CY, Patel MB, Miller MJ, Suhocki PV, Balius A, Smith TP. Gastrostomy-to-gastrojejunostomy tube conversion: impact of the method of original gastrostomy tube placement. J Vasc Interv Radiol. 2010;21:1031–7.

    Article  Google Scholar 

  40. • Lewis S, Jackson S, Latchford A. Randomized study of radiologic vs endoscopic placement of gastrojejunostomies in patients at risk of aspiration pneumonia. Nutr Clin Pract. 2014;29:498–503. A randomized study comparing radiologic versus endoscopic placement of gastrojejunostimes which demonstrated fewer reversible blockage and displacement in patients undergoing radiologic technique.

    Article  Google Scholar 

  41. Strong AT, Sharma G, Davis M, Mulcahy M, Punchai S, O’Rourke CP, et al. Direct percutaneous endoscopic jejunostomy (DPEJ) tube placement: a single institution experience and outcomes to 30 days and beyond. J Gastrointest Surg. 2017;21:446–52.

    Article  Google Scholar 

  42. Kim CY, Engstrom BI, Horvath JJ, Lungren MP, Suhocki PV, Smith TP. Comparison of primary jejunostomy tubes versus gastrojejunostomy tubes for percutaneous enteral nutrition. J Vasc Interv Radiol. 2013;24:1845–52.

    Article  Google Scholar 

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Authors and Affiliations

  1. Baylor College of Medicine, Houston, TX, USA

    David Hu

  2. Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA

    David Hu, Steven Huang & Rahul A. Sheth

  3. Department of Interventional Radiology, T. Boone Pickens Academic Tower (FCT14.5092), 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030, USA

    Rahul A. Sheth

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  1. David Hu
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Correspondence to Rahul A. Sheth.

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This article is part of the Topical Collection on Non-Vascular Interventional Radiology

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Hu, D., Huang, S. & Sheth, R.A. Gastric and Enteral Access for Feeding in Critically Ill Patients. Curr Trauma Rep 3, 190–195 (2017). https://doi.org/10.1007/s40719-017-0103-1

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  • DOI: https://doi.org/10.1007/s40719-017-0103-1

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