PEG

Evaluation of nutritional status and PEG dependence during chemoradiotherapy (2017)

Posted on by

Type of publication:
Conference abstract

Author(s):
*McLaughlin K , *Zuydam A, *Probert C ,Voyce C ,Grayson K

Citation:
British Association of Health and Neck Oncologists, BAHNO Annual Scientific Meeting, Royal College of Physicians, London, Friday 12th May 2017

Abstract:
Background: Chemoradiotherapy treatment for head and neck cancer can cause significant adverse side-effects that have the potential to impair nutritional status, physical functioning and quality of life. The aims of the study were to measure nutritional status and use of enteral tube feeding at the end of treatment and 3 months post-treatment and to assess the relationship between these factors and patient reported outcomes.

Methods: Subjects treated with chemotherapy and/or radiotherapy with curative intent were recruited prospectively over 18 months. Data were collected on 33 subjects with a diagnosis of primary squamous cell carcinoma of the oropharynx, nasopharynx or hypopharynx stage T1-4, N0-2b, M0 disease at baseline, at end of treatment and 3 months post-treatment. Nutrition outcomes were weight, percentage weight change, gastrostomy dependence (days of PEG use) and percentage of nutritional requirements met orally and via PEG.

Results:
As expected baseline BMI was significantly lower at end of treatment and 3 months post-treatment compared to baseline. The mean percentage weight loss of 5.6% during treatment is comparable to other studies. Mean nutrition via PEG was 85.0% and 35.6% of requirements at end of treatment and 3 months post-treatment respectively. Mean PEG dependence at 3 months was 85 days. There was a trend towards significance for increased weight loss and days of PEG use at 3 months (r=0.406).

Conclusions:
The data show some interesting trends, however the small sample size limited statistical analysis. Further research with a larger cohort is required to explore the findings further.

Percutaneous endoscopic gastrostomy (PEG) in disabled children - a bench marking exercise (2015)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Saran S.S., *Wasala D.W., *Ayub N.A.

Citation:
Archives of Disease in Childhood, April 2015, vol./is. 100/(A196)

Abstract:
Background: The Paediatric Gastroenterology Unit based at the Royal Shrewsbury Hospital provides a service for two hospitals. Its subsequent management is supported by the Community Paediatric Nurses. A benchmarking exercise of the PEG Service was undertaken and audited against the European Society for Parenteral and Enteral Nutrition (ESPEN) Guidelines. Methods All children with a PEG in-situ were identified from the Community Nurses PEG database. The electronic records of these patients were accessed for relevant data and input into a Microsoft Excel 2010 database by a single researcher. The ESPEN standards were used to audit the service in the relevant domains. Results 53 children with a PEG were identified. There was a clearly documented indication for a PEG in 96%, with neurologically disabled children at risk of aspiration comprising the largest group (47%). Feeding difficulties and Failure to thrive (FTT) made up 30% while other indications were Sensory Feeding Disorder in combination with other primary disorders (13%) dysmotility (4%) and metabolic causes (2%). The primary diagnosis was neurological in 55%, gastrointestinal 11%, renal 4% and cardiovascular, respiratory and endocrine 2% each. There were multiple diagnoses in 11% Nasogastric feeds were instituted and documented prior to the PEG in 94% and may have been used in a further 2% but not documented. More than half the children had their PEG sited at the age of 13-36 months (52%), a further 15% under 13 months while 20% were after the age of 36 months. Almost one third of the children (29%) had no complications from the PEG. Localised infection was the commonest complication (28%) with granulation tissue (13%), mechanical problems (dislodgement 8%, blockage 4%), skin ulceration (10%) and leakage (8%) as other complications. PEG feeds were succesful in improving the weight centiles of these patients. Parental satisfaction with the service could not be evaluated retrospectively. Conclusions The PEG Service at the Shrewsbury and Telford Hospitals NHS Trust adheres to ESPEN standards in the majority of patients and is associated with a low complication rate. Parental Satisfaction with the service should be sought prospectively.

Link to full-text: http://adc.bmj.com/content/100/Suppl_3/A196.1.full.pdf+html