Feasibility and results of pull-percutaneous endoscopic gastrostomy for enteral nutrition in adults with severe cerebral palsy. Issue 4 (August 2016)

• Record Type: Journal Article
• Authors: Davout, Ariane; Rech, Celia; Hanachi, Mouna; Barthod, Frederique; Melchior, Jean Claude; Crenn, Pascal
• Is Part Of: Clinical nutrition. Volume 35:Issue 4(2016:Aug.)
• Page Start: 918
• Page End: 923
• Publication Date: 2016-08
• Subjects: Enteral nutrition -- Percutaneous endoscopic gastrostomy (PEG) -- Cerebral palsy -- Undernutrition -- Swallowing disorders -- Chronic disease; CP cerebral palsy -- PEG percutaneous endoscopic gastrostomy -- GMCSF Gross Motor Function Classification System -- IQ intelligence quotient -- ASA American Society of Anesthesiologists -- AEs adverse events; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2015.06.007
• Languages: English
• ISSNs: 0261-5614

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.