Mo2027 - Multidisciplinary Care of Patients with Oropharyngeal Dysphagia Results in Successful Nasogastric Tube Weaning and Gastrostomy Tube Avoidance

2018 ◽  
Vol 154 (6) ◽  
pp. S-884
Author(s):  
Rachel Rosen ◽  
Kara Larson ◽  
Margot Lurie ◽  
Eliza Fishman ◽  
Elizabeth Dean ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Oropharyngeal Dysphagia ◽  
Multidisciplinary Care ◽  
Gastrostomy Tube ◽  
Tube Weaning

scholarly journals Button Gastrostomy Tubes for Pediatric Patients: A Tertiary Care Center Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Fayza Haider ◽  
Hasan Mohamed Ali Isa ◽  
Mohamed Amin Al Awadhi ◽  
Barrak Ayoub ◽  
Ezat Bakhsh ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Neurological Disorders ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Tube Feeding ◽  
Gastrostomy Tube ◽  
Tube Insertion ◽  
Main Indication ◽  
Nasogastric Tube Feeding ◽  
Button Gastrostomy

Background and Objective. Gastrostomy tube insertion is one of the most common procedures performed as a radical choice to overcome feeding difficulty in children. This study is aimed at describing the replacement of a button tube instead of the long tube for feeding infants and children requiring gastrostomies in a tertiary care hospital. Design and Setting. This retrospective cross-sectional descriptive study was conducted between January 2009 and August 2019 at Salmaniya Medical Complex which is a tertiary health care institute in the Kingdom of Bahrain. Subjects and Methods. Both charts and electronic health records of pediatric patients between the ages of 0 and 14 years were reviewed. Data were collected including age, sex, nationality, diagnosis, surgical information (procedure center and procedure performed), complications, and follow-up. Results. Out of 34 patients who underwent gastrostomy tube insertion, 30 patients had their long tube replaced by a button gastrostomy. Majority were males (N=18, 60%). Prolonged nasogastric tube feeding was the main indication of referral (N=17, 56%) followed by feed intolerance (N=6, 17%) and gastroesophageal reflux disease (N=5, 16%). The main underlying diseases at referral were neurological impairment (N=19, 63%) and metabolic disorders (N=4, 13%). There was no significant difference between patients with neurological disorders and other diseases in terms of gender, nationality, or age. Laparotomy with gastrostomy is the main approach used (N=18, 60%). No reported complications of button tubes in 50% of the patients (N=15). Conclusions. Prolonged nasogastric tube feeding is the main indication of referral for gastrostomy tube insertion. Neurological disorders are the main diagnosis for the cases operated upon. Laparotomy with gastrostomy is the procedure of choice at our center. Majority of patients had no reported complications of button tube replacement. These children are likely to benefit from the button tube with fewer complications.

scholarly journals Percutaneous Endoscopic Gastrostomy versus Nasogastric Tube Feeding: Oropharyngeal Dysphagia Increases Risk for Pneumonia Requiring Hospital Admission

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2969 ◽  
Author(s):  
Wei-Kuo Chang ◽  
Hsin-Hung Huang ◽  
Hsuan-Hwai Lin ◽  
Chen-Liang Tsai
Keyword(s):  
Hospital Admission ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Nasogastric Tube ◽  
Oropharyngeal Dysphagia ◽  
Tube Feeding ◽  
Pyriform Sinus ◽  
Control Group ◽  
Endoscopic Gastrostomy ◽  
Endoscopic Observation ◽  
Laryngeal Vestibule

Background: Aspiration pneumonia is the most common cause of death in patients with percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) feeding. This study aimed to compare PEG versus NGT feeding regarding the risk of pneumonia, according to the severity of pooling secretions in the pharyngolaryngeal region. Methods: Patients were stratified by endoscopic observation of the pooling secretions in the pharyngolaryngeal region: control group (<25% pooling secretions filling the pyriform sinus), pharyngeal group (25–100% pooling secretions filling the pyriform sinus), and laryngeal group (pooling secretions entering the laryngeal vestibule). Demographic data, swallowing level scale score, and pneumonia requiring hospital admission were recorded. Results: Patients with NGT (n = 97) had a significantly higher incidence of pneumonia (episodes/person-years) than those patients with PEG (n = 130) in the pharyngeal group (3.6 ± 1.0 vs. 2.3 ± 2.1, P < 0.001) and the laryngeal group (3.8 ± 0.5 vs. 2.3 ± 2.2 vs, P < 0.001). The risk of pneumonia was significantly higher in patients with NGT than in patients with PEG (adjusted hazard ratio = 2.85, 95% CI: 1.46–4.98, P < 0.001). Cumulative proportion of pneumonia was significantly higher in patients with NGT than with PEG for patients when combining the two groups (pharyngeal + laryngeal groups) (P = 0.035). Conclusion: PEG is a better choice than NGT feeding due to the decrease in risk of pneumonia requiring hospital admission, particularly in patients with abnormal amounts of pooling secretions accumulation in the pyriform sinus or leak into the laryngeal vestibule.

Antegrade and Retrograde Endoscopy for Treatment of Esophageal Stricture

2008 ◽  
Vol 74 (8) ◽  
pp. 686-688 ◽  
Author(s):  
Kaushik Mukherjee ◽  
Michael P. Cash ◽  
Brian B. Burkey ◽  
Wendell G. Yarbrough ◽  
James L. Netterville ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Esophageal Perforation ◽  
Esophageal Stricture ◽  
Gastrostomy Tube ◽  
Biopsy Forceps ◽  
Traditional Treatment ◽  
Esophageal Strictures ◽  
Multiple Processes

Total or near-total esophageal stricture results from multiple processes. Traditional treatment with wire cannulation followed by serial dilation is often contraindicated due to poor visualization and the risk of perforation. We seek to demonstrate that combined antegrade and retrograde endoscopy are useful for treatment of total or near-total esophageal strictures. The gastrostomy tube is removed and the tract dilated. A standard endoscope is passed retrograde to the stricture. An antegrade endoscope is advanced until transillumination across the stricture is visualized. A biopsy forceps or needle is used to traverse the stricture in an antegrade fashion. The tract is cannulated with a stiff wire that is then brought out through the gastrostomy site. The stricture is serially dilated. The gastrostomy tube is replaced, and a nasogastric tube is left across the stricture for 3 to 4 weeks. The endoscope is withdrawn and an 18 or 20 Fr gastrostomy tube is left in place. A total of three patients with total esophageal strictures were treated using combined antegrade and retrograde esophagoscopy. All three patients regained the ability to swallow secretions. Importantly, there were no instances of esophageal perforation. This technique has broader application, including combination with minilaparotomy for patients without retrograde access. Further research is needed to determine durability of stricture dilation.

scholarly journals Clinical Factors Associated With Successful Gastrostomy Tube Weaning in Patients With Prolonged Dysphagia After Stroke

2021 ◽  
Vol 45 (1) ◽  
pp. 33-41
Author(s):  
Bo Seong Jang ◽  
Jun Young Park ◽  
Jae Hyun Lee ◽  
Young Joo Sim ◽  
Ho Joong Jeong ◽  
...  
Keyword(s):  
Demographic Data ◽  
Characteristic Curve ◽  
Multiple Logistic Regression Analysis ◽  
Gastrostomy Tube ◽  
Screening Tools ◽  
Clinical Factors ◽  
Swallowing Function ◽  
Factors Associated ◽  
Korean Version ◽  
Tube Weaning

Objective To investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke.Methods This study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients’ demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated.Results There were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634–0.987) and PAS scores (OR=0.205; 95% CI, 0.059–0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively.Conclusion In patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning.

scholarly journals The relevance of the early terms of the formation of percutaneous endoscopic gastrostomy after a stroke complicated by severe neurogenic oropharyngeal dysphagia (review of the literature)

2019 ◽  
Vol 178 (3) ◽  
pp. 64-68
Author(s):  
K. V. Golubev ◽  
E. E. Topuzov ◽  
V. V. Oleynik ◽  
S. V. Gorchakov
Keyword(s):  
Quality Of Life ◽  
Gastroesophageal Reflux ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Oropharyngeal Dysphagia ◽  
Review Of The Literature ◽  
Subsequent Formation ◽  
Endoscopic Gastrostomy

Neurogenic oropharyngeal dysphagia (NOD) was a frequent complication after a stroke, determining the further prognosis and quality of life, causing a number of serious complications. Patients with severe NOD was recommended enteral feeding through the nasogastric tube (NGT) with the subsequent formation of a percutaneous endoscopic gastrostomy (PEG). Prolonged use of NGT had its own complications – sinusitis, gastroesophageal reflux, aspiration pneumonia, etc., and therefore it should be limited in time. In various recommendations, the length of terms before the formation of the PEG remained controversial. The analysis of modern tactics of PEG in patients after severely developed NOD was performed on the basis of literature data.

Gastrostomy Tube Supplementation for HIV-infected Children

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 696-702
Author(s):  
Tracie L. Miller ◽  
Ester L. Awnetwant ◽  
Sylvia Evans ◽  
Vivien M. Morris ◽  
Isabel M. Vazquez ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Gastrostomy Tube ◽  
Z Score ◽  
Cd4 Counts ◽  
Lower Weight ◽  
Z Scores ◽  
Hospital Days ◽  
Nasogastric Tube Feeding

Objective. Malnutrition is common in pediatric human immunodeficiency virus (HIV) infection, and little is known of effective nutritional interventions. We sought to determine whether enteral supplementation with gastrostomy tube feedings would provide improvements in weight, height, body composition, immune parameters, morbidity, and mortality. Methods. We collected clinical data on 23 HIV-in-fected children who were fed chronically by gastrostomy tube. The main outcome measures included weight, height, triceps skinfold thickness (TSF), arm-muscle circumference (AMC), hospital days, caloric intake, and CD4-positive T-lymphocyte count. Each of these parameters was measured or evaluated at four points: 6 months before nasogastric tube feeding, at the time nasogastric tube feeding was initiated, at the time gastrostomy tube feeding was initiated, and 6 months after gastrostomy tube feedings began. Results. Weight z score [-2.1 (0.14) to -1.58 (0.14)] and weight-for-height z score [-0.98 (0.16) to -0.15 (0.17)] improved with gastrostomy tube feedings. There was a trend toward improvement in weight z score with nasogastric tube feedings. Caloric intakes increased progressively with nasogastric and gastrostomy tube feedings. No improvement in height, TSF, AMC, hospital days, or CD4 counts was seen in the follow-up period. However, children who had the greatest increase in weight had the most improvement in fat stores (TSF) (r = .65, P = .002) and a decrease in hospital days after the gastrostomy tube was placed (r = -.48, P = .025). Higher age-adjusted CD4 counts and lower weight-for-height z scores at the time of enteral supplementation were significant predictors of a positive response to gastrostomy tube feedings(r = .85, P = .0001). Children who responded favorably had a 2.8-fold reduction in the risk of dying for every positive unit change in weight z score (P = .005). Conclusion. Gastrostomy tube supplementation for HIV-infected children can improve weight and fat mass when other oral methods fail. Weight gain is coincident with greater caloric intakes. HIV-infected children with higher CD4 counts and lower weight-for-height z scores are likely to respond favorably to gastrostomy tube feedings. Early nutritional intervention is indicated for HIV-infected children.

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