A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people
Objective: To compare the indications for and the outcome of long-term enteral feeding by nasogastric tube (NGT) with that of percutaneous endoscopic gastrostomy (PEG) tube. Design: A prospective, multicenter cohort study. Setting: Acute geriatric units and long-term care (LTC) hospitals in Jerusale...
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creator | DWOLATZKY, T. BEREZOVSKI, S. FRIEDMANN, R. PAZ, J. CLARFIELD, A.M. STESSMAN, J. HAMBURGER, R. JAUL, E. FRIEDLANDER, Y. ROSIN, A. SONNENBLICK, M. |
description | Objective: To compare the indications for and the outcome of long-term enteral feeding by nasogastric tube (NGT) with that of percutaneous endoscopic gastrostomy (PEG) tube. Design: A prospective, multicenter cohort study. Setting: Acute geriatric units and long-term care (LTC) hospitals in Jerusalem, Israel.Participants : 122 chronic patients aged 65 years and older for whom long-term enteral feeding was indicated as determined by the treating physician. Patients with acute medical conditions at the time of tube placement were excluded.Measurements : We examined the indications for enteral feeding, nutritional status, outcome and complications in all subjects. Subjects were followed for a minimum period of six months. Results: Although the PEG patients were older and had a higher incidence of dementia, there was an improved survival in those patients with PEG as compared to NGT (hazard ratio (HR)=0.41; 95% confidence interval (CI) 0.22–0.76; P=0.01). Also, the patients with PEG had a lower rate of aspiration (HR=0.48; 95% CI 0.26–0.89) and self-extubation (HR=0.17; 95% CI 0.05–0.58) than those with NGT. Apart from a significant improvement in the serum albumin level at the 4-week follow-up assessment in the patients with PEG compared to those with NGT (adjusted mean 3.35 compared to 3.08; F=4.982), nutritional status was otherwise similar in both groups. Conclusion: In long-term enteral feeding, in a selected group of non-acute patients, the use of PEG was associated with improved survival, was better tolerated by the patient and was associated with a lower incidence of aspiration. A randomized controlled study is needed to determine whether PEG is truly superior to NGT. |
doi_str_mv | 10.1054/clnu.2001.0489 |
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Design: A prospective, multicenter cohort study. Setting: Acute geriatric units and long-term care (LTC) hospitals in Jerusalem, Israel.Participants : 122 chronic patients aged 65 years and older for whom long-term enteral feeding was indicated as determined by the treating physician. Patients with acute medical conditions at the time of tube placement were excluded.Measurements : We examined the indications for enteral feeding, nutritional status, outcome and complications in all subjects. Subjects were followed for a minimum period of six months. Results: Although the PEG patients were older and had a higher incidence of dementia, there was an improved survival in those patients with PEG as compared to NGT (hazard ratio (HR)=0.41; 95% confidence interval (CI) 0.22–0.76; P=0.01). Also, the patients with PEG had a lower rate of aspiration (HR=0.48; 95% CI 0.26–0.89) and self-extubation (HR=0.17; 95% CI 0.05–0.58) than those with NGT. Apart from a significant improvement in the serum albumin level at the 4-week follow-up assessment in the patients with PEG compared to those with NGT (adjusted mean 3.35 compared to 3.08; F=4.982), nutritional status was otherwise similar in both groups. Conclusion: In long-term enteral feeding, in a selected group of non-acute patients, the use of PEG was associated with improved survival, was better tolerated by the patient and was associated with a lower incidence of aspiration. A randomized controlled study is needed to determine whether PEG is truly superior to NGT.</description><identifier>ISSN: 0261-5614</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1054/clnu.2001.0489</identifier><identifier>PMID: 11884002</identifier><identifier>CODEN: CLNUDP</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cohort Studies ; Elderly ; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition ; Endoscopy ; enteral feeding ; Enteral Nutrition - methods ; Female ; Gastrostomy ; Humans ; Incidence ; Intensive care medicine ; Intubation, Gastrointestinal - adverse effects ; Intubation, Gastrointestinal - methods ; Male ; Medical sciences ; Metabolic diseases ; nasogastric tube ; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...) ; percutaneous endoscopic gastrostomy ; Prospective Studies ; Time Factors ; Treatment Outcome</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2001-12, Vol.20 (6), p.535-540</ispartof><rights>2001 Harcourt Publishers Ltd</rights><rights>2002 INIST-CNRS</rights><rights>Copyright 2001 Harcourt Publishers Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-23411dd8ebc15609912cd21a1578982e0ff7ea86660d0f675fb657b022f3ecc23</citedby><cites>FETCH-LOGICAL-c458t-23411dd8ebc15609912cd21a1578982e0ff7ea86660d0f675fb657b022f3ecc23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1054/clnu.2001.0489$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://igdc.huji.ac.il/home/Maagar/Details.aspx?AN=115$$D View record in IGDC$$Hfree_for_read</backlink><backlink>$$Uhttp://dx.doi.org/10.1054/clnu.2001.0489$$D View full text (Access may be restricted)$$Hfree_for_read</backlink><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13444193$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11884002$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DWOLATZKY, T.</creatorcontrib><creatorcontrib>BEREZOVSKI, S.</creatorcontrib><creatorcontrib>FRIEDMANN, R.</creatorcontrib><creatorcontrib>PAZ, J.</creatorcontrib><creatorcontrib>CLARFIELD, A.M.</creatorcontrib><creatorcontrib>STESSMAN, J.</creatorcontrib><creatorcontrib>HAMBURGER, R.</creatorcontrib><creatorcontrib>JAUL, E.</creatorcontrib><creatorcontrib>FRIEDLANDER, Y.</creatorcontrib><creatorcontrib>ROSIN, A.</creatorcontrib><creatorcontrib>SONNENBLICK, M.</creatorcontrib><title>A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description>Objective: To compare the indications for and the outcome of long-term enteral feeding by nasogastric tube (NGT) with that of percutaneous endoscopic gastrostomy (PEG) tube. Design: A prospective, multicenter cohort study. Setting: Acute geriatric units and long-term care (LTC) hospitals in Jerusalem, Israel.Participants : 122 chronic patients aged 65 years and older for whom long-term enteral feeding was indicated as determined by the treating physician. Patients with acute medical conditions at the time of tube placement were excluded.Measurements : We examined the indications for enteral feeding, nutritional status, outcome and complications in all subjects. Subjects were followed for a minimum period of six months. Results: Although the PEG patients were older and had a higher incidence of dementia, there was an improved survival in those patients with PEG as compared to NGT (hazard ratio (HR)=0.41; 95% confidence interval (CI) 0.22–0.76; P=0.01). Also, the patients with PEG had a lower rate of aspiration (HR=0.48; 95% CI 0.26–0.89) and self-extubation (HR=0.17; 95% CI 0.05–0.58) than those with NGT. Apart from a significant improvement in the serum albumin level at the 4-week follow-up assessment in the patients with PEG compared to those with NGT (adjusted mean 3.35 compared to 3.08; F=4.982), nutritional status was otherwise similar in both groups. Conclusion: In long-term enteral feeding, in a selected group of non-acute patients, the use of PEG was associated with improved survival, was better tolerated by the patient and was associated with a lower incidence of aspiration. A randomized controlled study is needed to determine whether PEG is truly superior to NGT.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Elderly</subject><subject>Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition</subject><subject>Endoscopy</subject><subject>enteral feeding</subject><subject>Enteral Nutrition - methods</subject><subject>Female</subject><subject>Gastrostomy</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intensive care medicine</subject><subject>Intubation, Gastrointestinal - adverse effects</subject><subject>Intubation, Gastrointestinal - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metabolic diseases</subject><subject>nasogastric tube</subject><subject>Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...)</subject><subject>percutaneous endoscopic gastrostomy</subject><subject>Prospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0261-5614</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kT9v3SAUxa2qVfOSdu3WiqXZ_MrFxsZjFPWfFKlLOyMMlxcqDC7YkfIl8pmL6ydl6nSR7o8D55yqegf0CJS3n7QP65FRCkfaiuFFdQDesBoG0bysDpR1UPMO2ovqMufflFLe9OJ1dQEgREspO1RPN2ROMc-oF_eARMdpVsnlGEi0ZLlHsmbcjkHleFJ5SU4TFQyZMel1UQHjmgkGE7OOc9n9Y2Je4vRIlnXETGxMxMdwqhdMU0HLUJ5YROPCibjykDeYimCcPb6pXlnlM749z6vq15fPP2-_1Xc_vn6_vbmrdcvFUrOmBTBG4KiBd3QYgGnDQAHvxSAYUmt7VKLrOmqo7Xpux473I2XMNqg1a66q6123mP-zYl7k5LJG73dHsgcmGEBXwOMO6uIqJ7RyTm5S6VEClVsDcmtAbg3IrYFy4cNZeR0nNM_4OfICfDwDKmvlbVJBu_zMNW3bwtAU7v3OuZPRcnSjd_GU1HzvdBHjZS_2PZacHhwmmbXDoEuuqbQpTXT_--NfHZ6vQA</recordid><startdate>20011201</startdate><enddate>20011201</enddate><creator>DWOLATZKY, T.</creator><creator>BEREZOVSKI, S.</creator><creator>FRIEDMANN, R.</creator><creator>PAZ, J.</creator><creator>CLARFIELD, A.M.</creator><creator>STESSMAN, J.</creator><creator>HAMBURGER, R.</creator><creator>JAUL, E.</creator><creator>FRIEDLANDER, Y.</creator><creator>ROSIN, A.</creator><creator>SONNENBLICK, M.</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>AGDVQ</scope><scope>IQODW</scope><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></search><sort><creationdate>20011201</creationdate><title>A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people</title><author>DWOLATZKY, T. ; BEREZOVSKI, S. ; FRIEDMANN, R. ; PAZ, J. ; CLARFIELD, A.M. ; STESSMAN, J. ; HAMBURGER, R. ; JAUL, E. ; FRIEDLANDER, Y. ; ROSIN, A. ; SONNENBLICK, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-23411dd8ebc15609912cd21a1578982e0ff7ea86660d0f675fb657b022f3ecc23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Elderly</topic><topic>Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition</topic><topic>Endoscopy</topic><topic>enteral feeding</topic><topic>Enteral Nutrition - methods</topic><topic>Female</topic><topic>Gastrostomy</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intensive care medicine</topic><topic>Intubation, Gastrointestinal - adverse effects</topic><topic>Intubation, Gastrointestinal - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metabolic diseases</topic><topic>nasogastric tube</topic><topic>Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...)</topic><topic>percutaneous endoscopic gastrostomy</topic><topic>Prospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DWOLATZKY, T.</creatorcontrib><creatorcontrib>BEREZOVSKI, S.</creatorcontrib><creatorcontrib>FRIEDMANN, R.</creatorcontrib><creatorcontrib>PAZ, J.</creatorcontrib><creatorcontrib>CLARFIELD, A.M.</creatorcontrib><creatorcontrib>STESSMAN, J.</creatorcontrib><creatorcontrib>HAMBURGER, R.</creatorcontrib><creatorcontrib>JAUL, E.</creatorcontrib><creatorcontrib>FRIEDLANDER, Y.</creatorcontrib><creatorcontrib>ROSIN, A.</creatorcontrib><creatorcontrib>SONNENBLICK, M.</creatorcontrib><collection>IGDC Bibliographic Database - מאגר לחקר ההזדקנות</collection><collection>Pascal-Francis</collection><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>DWOLATZKY, T.</au><au>BEREZOVSKI, S.</au><au>FRIEDMANN, R.</au><au>PAZ, J.</au><au>CLARFIELD, A.M.</au><au>STESSMAN, J.</au><au>HAMBURGER, R.</au><au>JAUL, E.</au><au>FRIEDLANDER, Y.</au><au>ROSIN, A.</au><au>SONNENBLICK, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2001-12-01</date><risdate>2001</risdate><volume>20</volume><issue>6</issue><spage>535</spage><epage>540</epage><pages>535-540</pages><issn>0261-5614</issn><eissn>1532-1983</eissn><coden>CLNUDP</coden><abstract>Objective: To compare the indications for and the outcome of long-term enteral feeding by nasogastric tube (NGT) with that of percutaneous endoscopic gastrostomy (PEG) tube. Design: A prospective, multicenter cohort study. Setting: Acute geriatric units and long-term care (LTC) hospitals in Jerusalem, Israel.Participants : 122 chronic patients aged 65 years and older for whom long-term enteral feeding was indicated as determined by the treating physician. Patients with acute medical conditions at the time of tube placement were excluded.Measurements : We examined the indications for enteral feeding, nutritional status, outcome and complications in all subjects. Subjects were followed for a minimum period of six months. Results: Although the PEG patients were older and had a higher incidence of dementia, there was an improved survival in those patients with PEG as compared to NGT (hazard ratio (HR)=0.41; 95% confidence interval (CI) 0.22–0.76; P=0.01). Also, the patients with PEG had a lower rate of aspiration (HR=0.48; 95% CI 0.26–0.89) and self-extubation (HR=0.17; 95% CI 0.05–0.58) than those with NGT. Apart from a significant improvement in the serum albumin level at the 4-week follow-up assessment in the patients with PEG compared to those with NGT (adjusted mean 3.35 compared to 3.08; F=4.982), nutritional status was otherwise similar in both groups. Conclusion: In long-term enteral feeding, in a selected group of non-acute patients, the use of PEG was associated with improved survival, was better tolerated by the patient and was associated with a lower incidence of aspiration. A randomized controlled study is needed to determine whether PEG is truly superior to NGT.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>11884002</pmid><doi>10.1054/clnu.2001.0489</doi><tpages>6</tpages></addata></record> |
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subjects | Age Factors Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cohort Studies Elderly Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition Endoscopy enteral feeding Enteral Nutrition - methods Female Gastrostomy Humans Incidence Intensive care medicine Intubation, Gastrointestinal - adverse effects Intubation, Gastrointestinal - methods Male Medical sciences Metabolic diseases nasogastric tube Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...) percutaneous endoscopic gastrostomy Prospective Studies Time Factors Treatment Outcome |
title | A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people |
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