Feasibility and results of pull-percutaneous endoscopic gastrostomy for enteral nutrition in adults with severe cerebral palsy
Summary Background & aims Eating and swallowing impairments often get worse as patients with severe cerebral palsy (CP) get older, creating increased demand for percutaneous endoscopic gastrostomy (PEG) tube placement. Here we investigated the feasibility, safety, adverse events (AEs) and outcom...
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| Veröffentlicht in: | Clinical nutrition (Edinburgh, Scotland) Scotland), 2016-08, Vol.35 (4), p.918-923 |
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| creator | Davout, Ariane Rech, Celia Hanachi, Mouna Barthod, Frederique Melchior, Jean Claude Crenn, Pascal |
| description | Summary Background & aims Eating and swallowing impairments often get worse as patients with severe cerebral palsy (CP) get older, creating increased demand for percutaneous endoscopic gastrostomy (PEG) tube placement. Here we investigated the feasibility, safety, adverse events (AEs) and outcomes of PEG in adult CP. Methods We performed a retrospective study of 26 consecutive severe adult (age: 28 [19–48] yrs) CP patients who underwent pull-PEG tube placement under general anesthesia between 2005 and 2012 (median follow-up: 23 [6–64] months) at the same tertiary hospital centre. Results The procedure was a technical success for 19 patients (BMI: 13.8 [10.7–21.4]) with (n = 11) or without (n = 8) previous respiratory disorder. Indications were mainly swallowing disorders (n = 14) and inadequate oral intake (n = 8). Early AEs were 7 transient oxygen needs, 3 local wound infections and 2 transient ileus. Long-term AEs were 9 non-severe gastrostomy incidents. There was no significant improvement in neurological status but respiratory function was improved in 6 patients and enteral nutrition enabled a significant median weight gain of 4.2 [1–8.8] kg (P |
| doi_str_mv | 10.1016/j.clnu.2015.06.007 |
| format | Article |
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Here we investigated the feasibility, safety, adverse events (AEs) and outcomes of PEG in adult CP. Methods We performed a retrospective study of 26 consecutive severe adult (age: 28 [19–48] yrs) CP patients who underwent pull-PEG tube placement under general anesthesia between 2005 and 2012 (median follow-up: 23 [6–64] months) at the same tertiary hospital centre. Results The procedure was a technical success for 19 patients (BMI: 13.8 [10.7–21.4]) with (n = 11) or without (n = 8) previous respiratory disorder. Indications were mainly swallowing disorders (n = 14) and inadequate oral intake (n = 8). Early AEs were 7 transient oxygen needs, 3 local wound infections and 2 transient ileus. Long-term AEs were 9 non-severe gastrostomy incidents. There was no significant improvement in neurological status but respiratory function was improved in 6 patients and enteral nutrition enabled a significant median weight gain of 4.2 [1–8.8] kg (P < 0.01). Quality-of-life assessed by relatives and the healthcare team was improved in 13/16 and 13/15 cases respectively. AEs and outcomes did not differ significantly with previous respiratory disorder or nutritional status. Conclusions PEG tube placement is feasible in adult CP, although the risk of failure is increased by anatomical specificities. Previous respiratory disorders and undernourishment did not increase AE rates or modify outcomes. There were positive changes over time for nutritional status and perceived quality-of-life, but no neurological improvement.</description><identifier>ISSN: 0261-5614</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/j.clnu.2015.06.007</identifier><identifier>PMID: 26209255</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Cerebral palsy ; Cerebral Palsy - therapy ; Chronic disease ; Deglutition Disorders - therapy ; Endoscopy, Gastrointestinal ; Enteral nutrition ; Enteral Nutrition - methods ; Feasibility Studies ; Female ; Follow-Up Studies ; Gastroenterology and Hepatology ; Gastrostomy ; Humans ; Intubation, Gastrointestinal ; Male ; Middle Aged ; Nutritional Status ; Percutaneous endoscopic gastrostomy (PEG) ; Retrospective Studies ; Swallowing disorders ; Tertiary Care Centers ; Treatment Outcome ; Undernutrition ; Young Adult</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2016-08, Vol.35 (4), p.918-923</ispartof><rights>2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-2ae1a72d2f7a42f7609e1b39e14eeef8d68baa4d71e03bd588445b047d9103443</citedby><cites>FETCH-LOGICAL-c411t-2ae1a72d2f7a42f7609e1b39e14eeef8d68baa4d71e03bd588445b047d9103443</cites><orcidid>0000-0002-8213-2319</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.clnu.2015.06.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26209255$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Davout, Ariane</creatorcontrib><creatorcontrib>Rech, Celia</creatorcontrib><creatorcontrib>Hanachi, Mouna</creatorcontrib><creatorcontrib>Barthod, Frederique</creatorcontrib><creatorcontrib>Melchior, Jean Claude</creatorcontrib><creatorcontrib>Crenn, Pascal</creatorcontrib><title>Feasibility and results of pull-percutaneous endoscopic gastrostomy for enteral nutrition in adults with severe cerebral palsy</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description>Summary Background & aims Eating and swallowing impairments often get worse as patients with severe cerebral palsy (CP) get older, creating increased demand for percutaneous endoscopic gastrostomy (PEG) tube placement. Here we investigated the feasibility, safety, adverse events (AEs) and outcomes of PEG in adult CP. Methods We performed a retrospective study of 26 consecutive severe adult (age: 28 [19–48] yrs) CP patients who underwent pull-PEG tube placement under general anesthesia between 2005 and 2012 (median follow-up: 23 [6–64] months) at the same tertiary hospital centre. Results The procedure was a technical success for 19 patients (BMI: 13.8 [10.7–21.4]) with (n = 11) or without (n = 8) previous respiratory disorder. Indications were mainly swallowing disorders (n = 14) and inadequate oral intake (n = 8). Early AEs were 7 transient oxygen needs, 3 local wound infections and 2 transient ileus. Long-term AEs were 9 non-severe gastrostomy incidents. There was no significant improvement in neurological status but respiratory function was improved in 6 patients and enteral nutrition enabled a significant median weight gain of 4.2 [1–8.8] kg (P < 0.01). Quality-of-life assessed by relatives and the healthcare team was improved in 13/16 and 13/15 cases respectively. AEs and outcomes did not differ significantly with previous respiratory disorder or nutritional status. Conclusions PEG tube placement is feasible in adult CP, although the risk of failure is increased by anatomical specificities. Previous respiratory disorders and undernourishment did not increase AE rates or modify outcomes. There were positive changes over time for nutritional status and perceived quality-of-life, but no neurological improvement.</description><subject>Adult</subject><subject>Cerebral palsy</subject><subject>Cerebral Palsy - therapy</subject><subject>Chronic disease</subject><subject>Deglutition Disorders - therapy</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Enteral nutrition</subject><subject>Enteral Nutrition - methods</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastrostomy</subject><subject>Humans</subject><subject>Intubation, Gastrointestinal</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nutritional Status</subject><subject>Percutaneous endoscopic gastrostomy (PEG)</subject><subject>Retrospective Studies</subject><subject>Swallowing disorders</subject><subject>Tertiary Care Centers</subject><subject>Treatment Outcome</subject><subject>Undernutrition</subject><subject>Young Adult</subject><issn>0261-5614</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU-LFDEQxYMo7uzqF_AgOXrptpJO_xkQQRbXFRY8qOAtpJNqzZhJ2iS9S1_87Kad1YMHL1WHeu_B-xUhzxjUDFj38lBr55eaA2tr6GqA_gHZsbbhFdsPzUOyA96xqu2YOCPnKR0AoG364TE54x2HPW_bHfl5hSrZ0TqbV6q8oRHT4nKiYaLz4lw1Y9RLVh7Dkih6E5IOs9X0q0o5hpTDcaVTiOWUMSpH_ZKjzTZ4aj1V5nfWnc3faMJbjEh1GeMmnJVL6xPyaCobn97vC_L56u2ny-vq5sO795dvbiotGMsVV8hUzw2feiXK6GCPbGzKEIg4DaYbRqWE6RlCM5p2GIRoRxC92TNohGguyItT7hzDjwVTlkebNDp3KiZZvxeiByagSPlJqku9FHGSc7RHFVfJQG7c5UFu3OXGXUInC_dien6fv4xHNH8tf0AXwauTAEvLW4tRJm3RazQ2os7SBPv__Nf_2LWz3mrlvuOK6RCW6As_yWTiEuTH7fPb41kLwAb-pfkFuPisRw</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Davout, Ariane</creator><creator>Rech, Celia</creator><creator>Hanachi, Mouna</creator><creator>Barthod, Frederique</creator><creator>Melchior, Jean Claude</creator><creator>Crenn, Pascal</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8213-2319</orcidid></search><sort><creationdate>20160801</creationdate><title>Feasibility and results of pull-percutaneous endoscopic gastrostomy for enteral nutrition in adults with severe cerebral palsy</title><author>Davout, Ariane ; Rech, Celia ; Hanachi, Mouna ; Barthod, Frederique ; Melchior, Jean Claude ; Crenn, Pascal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-2ae1a72d2f7a42f7609e1b39e14eeef8d68baa4d71e03bd588445b047d9103443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Cerebral palsy</topic><topic>Cerebral Palsy - therapy</topic><topic>Chronic disease</topic><topic>Deglutition Disorders - therapy</topic><topic>Endoscopy, Gastrointestinal</topic><topic>Enteral nutrition</topic><topic>Enteral Nutrition - methods</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastrostomy</topic><topic>Humans</topic><topic>Intubation, Gastrointestinal</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nutritional Status</topic><topic>Percutaneous endoscopic gastrostomy (PEG)</topic><topic>Retrospective Studies</topic><topic>Swallowing disorders</topic><topic>Tertiary Care Centers</topic><topic>Treatment Outcome</topic><topic>Undernutrition</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Davout, Ariane</creatorcontrib><creatorcontrib>Rech, Celia</creatorcontrib><creatorcontrib>Hanachi, Mouna</creatorcontrib><creatorcontrib>Barthod, Frederique</creatorcontrib><creatorcontrib>Melchior, Jean Claude</creatorcontrib><creatorcontrib>Crenn, Pascal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Davout, Ariane</au><au>Rech, Celia</au><au>Hanachi, Mouna</au><au>Barthod, Frederique</au><au>Melchior, Jean Claude</au><au>Crenn, Pascal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Feasibility and results of pull-percutaneous endoscopic gastrostomy for enteral nutrition in adults with severe cerebral palsy</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>35</volume><issue>4</issue><spage>918</spage><epage>923</epage><pages>918-923</pages><issn>0261-5614</issn><eissn>1532-1983</eissn><abstract>Summary Background & aims Eating and swallowing impairments often get worse as patients with severe cerebral palsy (CP) get older, creating increased demand for percutaneous endoscopic gastrostomy (PEG) tube placement. Here we investigated the feasibility, safety, adverse events (AEs) and outcomes of PEG in adult CP. Methods We performed a retrospective study of 26 consecutive severe adult (age: 28 [19–48] yrs) CP patients who underwent pull-PEG tube placement under general anesthesia between 2005 and 2012 (median follow-up: 23 [6–64] months) at the same tertiary hospital centre. Results The procedure was a technical success for 19 patients (BMI: 13.8 [10.7–21.4]) with (n = 11) or without (n = 8) previous respiratory disorder. Indications were mainly swallowing disorders (n = 14) and inadequate oral intake (n = 8). Early AEs were 7 transient oxygen needs, 3 local wound infections and 2 transient ileus. Long-term AEs were 9 non-severe gastrostomy incidents. There was no significant improvement in neurological status but respiratory function was improved in 6 patients and enteral nutrition enabled a significant median weight gain of 4.2 [1–8.8] kg (P < 0.01). Quality-of-life assessed by relatives and the healthcare team was improved in 13/16 and 13/15 cases respectively. AEs and outcomes did not differ significantly with previous respiratory disorder or nutritional status. Conclusions PEG tube placement is feasible in adult CP, although the risk of failure is increased by anatomical specificities. Previous respiratory disorders and undernourishment did not increase AE rates or modify outcomes. There were positive changes over time for nutritional status and perceived quality-of-life, but no neurological improvement.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>26209255</pmid><doi>10.1016/j.clnu.2015.06.007</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-8213-2319</orcidid></addata></record> |
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| subjects | Adult Cerebral palsy Cerebral Palsy - therapy Chronic disease Deglutition Disorders - therapy Endoscopy, Gastrointestinal Enteral nutrition Enteral Nutrition - methods Feasibility Studies Female Follow-Up Studies Gastroenterology and Hepatology Gastrostomy Humans Intubation, Gastrointestinal Male Middle Aged Nutritional Status Percutaneous endoscopic gastrostomy (PEG) Retrospective Studies Swallowing disorders Tertiary Care Centers Treatment Outcome Undernutrition Young Adult |
| title | Feasibility and results of pull-percutaneous endoscopic gastrostomy for enteral nutrition in adults with severe cerebral palsy |
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