scholarly journals P-OGC58 Preoperative Enteral Feeding in Patients with Oesophagogastric Cancer

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Cathy White ◽  
Mayilone Arumugusamy ◽  
William Robb
Keyword(s):  
Weight Loss ◽  
Enteral Feeding ◽  
Patient Flow ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Tube Insertion ◽  
Jejunostomy Tube ◽  
Curative Intent ◽  
Additional Support ◽  
The Impact

Abstract Background Patients with Oesophagogastric (OG) cancer undergoing multimodal treatment have a higher risk for progressive decline in their nutritional status. Our centre has seen increased numbers of patients using jejunostomy and gastrostomy tube feeding as an additional support during neoadjuvant chemotherapy and radiotherapy (nCRT).  This audit aimed to evaluate the processes surrounding and the impact of this intervention. Methods A retrospective review of 2019 medical records.  Patients with OG cancer for treatment with curative intent that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Results 14 patients were admitted for elective feeding tube insertion in 2019. On admission N = 10 patients (71%) had clinically severe weight loss (defined as ≥ 10% in 6 months, or ≥ 7.5% in 3 months or ≥ 5% in 1 month).  Four (29%) had a dietetic assessment pre admission, with 1 patient (7%) trained on home enteral nutrition pre admission. Conclusions This service is growing rapidly, patient numbers have more than doubled in 3 years. Enteral feeding is effective in preventing clinically significant weight loss in patients undergoing nCRT who progress to surgery. Short LOS: dietetic consult pre admission is essential to improve patient flow, education, preparation. Jejunostomy tube dislodged in 46% patients (n = 6), aim to improve strategies to avoid or best manage this.   For future work: Examine effect on body composition (CT: sarcopenia) and examine patient’s perspectives and quality of life.

Proactive versus reactive feeding tube (FT) placement in head and neck cancer patients (HNC pts) receiving chemoradiation (CRT).

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 11-11
Author(s):  
Thunnisa Sivananth ◽  
Maureen Quinn ◽  
Rae-Ann Stortz ◽  
David A. Palma ◽  
Peggy Francis ◽  
...  
Keyword(s):  
Weight Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Treatment Interruption ◽  
Feeding Tube ◽  
Nutritional Management ◽  
Swallowing Function ◽  
Platinum Based Chemotherapy ◽  
Optimal Approach ◽  
The Impact

11 Background: Most HNC pts treated with CRT develop severe treatment-related oropharyngeal mucositis. For pts with adequate nutritional status and swallowing function prior to CRT the optimal approach to nutritional management remains undefined. A subset of pts will require FTs to complete treatment, but at least 50% of pts with prophylactic FTs never use them (Madhoun 2011). At our center we have used a "reactive" approach which minimizes exposure to unnecessary FT placement. However, some pts suffer nutritional crises resulting in hospitalization, treatment interruption, and higher risks of complications from FT placement. We investigated the impact of a more proactive approach to FT placement in our pts. Methods: HNC pts treated with CRT who received a FT during treatment 2014-2018 were retrospectively identified from electronic medical records and clinical data extracted. "Proactive" FTs were not considered medically necessary but were placed within 15 days of starting CRT. Primary outcomes of interest were weight loss during CRT (WTL), FT complications, length of hospital stay and FT duration. Uni- and multivariate analyses were done and p values < 0.05 considered of interest. Results: 124 pts were identified: 87% male, median age 62.5 yrs (39-80) and 67% oropharyngeal primary. All received platinum-based chemotherapy or cetuximab (8 pts). 19 FTs were considered medically necessary, 94 were placed reactively and 11 placed proactively; 91% were percutaneous and 94% were used. Median weight was 79.0 kg (27.6-165.7) prior to CRT and 71.2 kg (26.8-148.2) after. Median WTL was 9.9% (-13.9 to 33.3%). Proactive FT placement was associated with less WTL (p = 0.045). WTL was greater in pts over age 65 (OR 11.6 [1.4-97.6]). Hospital stay was longer for pts who had reactive FT. Females had longer FT duration (p = 0.005). Conclusions: These data suggest that when a reactive approach to FT placement is used, earlier FT placement during CRT is more effective at reducing weight loss and hospitalization time in this population. Specific criteria for pt selection with this approach should be defined. Further research to define the optimal approach to nutritional management in HNC pts receiving CRT is needed.

scholarly journals Formulation of enteral diets for use in jejunal enteral feeding

2008 ◽  
Vol 67 (3) ◽  
pp. 270-272 ◽  
Author(s):  
D. B. A. Silk
Keyword(s):  
Enteral Feeding ◽  
Pancreatic Secretion ◽  
Peptide Yy ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Enteral Diet ◽  
Feeding Technique ◽  
Pancreatic Exocrine ◽  
Glucagon Like Peptide 1 ◽  
Feeding Techniques

Nasogastric enteral feeding is not tolerated in patients with gastric atony and in many critically-ill patients in whom gastric emptying may be delayed and in whom gastro-oesophageal regurgitation may lead to pulmonary aspiration of enteral feed and the development of pneumonia. Initial attempts to overcome these problems led to the development of post pyloric enteral feeding techniques with the infusion port of the tubes positioned in the duodenum. In many centres this technique is still the most practised post-pyloric enteral feeding technique. Nasoduodenal feeding tubes often retroperistalse into the stomach. The technique of choice, therefore, in these difficult patients is to position the infusion port of the feeding tube well distal to the ligament of trietz (post ligament of trietz nasojejunal enteral tube feeding). While nasogastric and nasoduodenal enteral feeding techniques have been shown to elicit a stimulatory exocrine pancreatic response, distal jejunal enteral feeding does not. During this mode of feeding the ileal brake is activated and pancreatic exocrine pancreatic secretion inhibited by the action of the released peptide YY and glucagon-like peptide-1 hormones, in turn the inhibition of pancreatic secretion being the result of inhibition of trypsin secretion. In the light of the findings showing the absence of a stimulatory pancreatic exocrine response to nasojejunal enteral feeding these patients should receive a predigested rather than a polymeric enteral diet.

Pharmacist Intervention Enhances Adherence to Orlistat Therapy

2003 ◽  
Vol 37 (11) ◽  
pp. 1598-1602 ◽  
Author(s):  
Margaret Malone ◽  
Sharon A Alger-Mayer
Keyword(s):  
Weight Loss ◽  
Pharmaceutical Care ◽  
Pharmacist Intervention ◽  
Community Practice ◽  
Management Skills ◽  
Large Numbers ◽  
Number Of Patients ◽  
Significant Difference ◽  
Additional Support ◽  
The Impact

BACKGROUND: Pharmacists, especially those in community practice, should increase their level of intervention in dealing with the nationwide epidemic of obesity since they interact with large numbers of the public on a regular basis. We hypothesized that patients who receive medication for weight loss may have an improved therapeutic outcome if they received additional support from their community pharmacist. OBJECTIVE: To evaluate the impact of pharmacist support on patient persistence with orlistat. METHODS: Pharmacists were trained in basic obesity management skills. Patients who were prescribed orlistat and attending an outpatient nutrition program were invited to participate in the study. All patients agreed to receive pharmaceutical care. Those who lived where the service was available were assigned to the intervention (I) group and those who did not were assigned to the control (C) group. All patients received usual care provided by the outpatient clinic. RESULTS: Thirty patients, 15 in the I group and 15 in the C group, were recruited. Both groups were predominantly women (87%) with a mean ± SD age of 43.8 ± 9.7 years. Patients in the I group had significantly greater persistence with orlistat therapy as assessed by duration of therapy (p = 0.006) and number of patients completing the 26-week study (7 I, 2 C; p = 0.046). There was no significant difference in percent of weight loss between groups (p > 0.05). CONCLUSIONS: In this pilot study, patients receiving pharmaceutical care took orlistat longer than the controls and had improved outcome with orlistat therapy.

scholarly journals Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3177
Author(s):  
Rishi Jain ◽  
Talha Shaikh ◽  
Jia-Llon Yee ◽  
Cherry Au ◽  
Crystal S. Denlinger ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Nutritional Status ◽  
Neoadjuvant Chemoradiotherapy ◽  
Hematologic Toxicity ◽  
Clinical Markers ◽  
Jejunostomy Tube ◽  
Feeding Jejunostomy ◽  
Reduce Weight Loss ◽  
The Impact

Background: Patients with esophageal cancer (EC) have high rates of malnutrition due to tumor location and treatment-related toxicity. Various strategies are used to improve nutritional status in patients with EC including oral and enteral support. Methods: We conducted a retrospective analysis to determine the impact of malnutrition and prophylactic feeding jejunostomy tube (FJT) placement on toxicity and outcomes in patients with localized EC who were treated with neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy. Results: We identified 125 patients who were treated with nCRT between 2002 and 2014. Weight loss and hypoalbuminemia occurred frequently during nCRT and were associated with multiple adverse toxicity outcomes including hematologic toxicity, nonhematologic toxicity, grade ≥3 toxicity, and hospitalizations. After adjusting for relevant covariates including the specific nCRT chemotherapy regimen received and the onset of toxicity, there were no significant associations between hypoalbuminemia, weight loss, or FJT placement and relapse-free survival (RFS) or overall survival (OS). FJT placement was associated with less weight loss during nCRT (p = 0.003) but was not associated with reduced toxicity or improved survival. Conclusions: Weight and albumin loss during nCRT for EC are important factors relating to treatment toxicity but not RFS or OS. While pretreatment FJT placement may reduce weight loss, it may not impact treatment tolerance or survival.

Nasogastric versus Orogastric Bolus Tube Feeding in Preterm Infants: Pilot Randomized Clinical Trial

2020 ◽  
Author(s):  
Ahmed Tawfik Badran ◽  
Menna Hashish ◽  
Alaa Ali ◽  
Mohamed Shokeir ◽  
Abd Shabaan
Keyword(s):  
Clinical Trial ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Incidence Rates ◽  
Orogastric Tube ◽  
Nasogastric Tube Feeding ◽  
Full Enteral Feeding

Objective According to the most recent metanalysis, the best way to establish safe enteral feeding in preterm babies using nasogastric or orogastric tubes is still not well understood. This study aimed to determine the effects of bolus nasal tubes versus bolus orogastric tubes on the time required to reach full enteral feeding in preterm infants, as well as to compare the incidence rates of adverse events including nonintentional removal or displacement of the feeding tube, aspiration pneumonia/pneumonitis, apnea, necrotizing enterocolitis, gastric residual, and growth parameters between the studied cohort of preterm infants. Study Design We conducted an unblinded pilot randomized clinical trial on hemodynamically stable preterm infants (>28 weeks) recruited from level 2 neonatal intensive care unit at Mansoura University Children's Hospital from June 2015 to May 2017. Results Our study included 98 stable preterm infants with mean gestational age (orogastric group: 33.27 ± 1.08, nasogastric group: 33.32 ± 1.57) and mean birthweight (orogastric group: 1,753.3 ± 414.51, nasogastric group: 1,859.6 ± 307.05). Preterm infants who were fed via bolus nasogastric tube achieved full enteral feeding in a significantly shorter duration compared with the infants fed via bolus orogastric tube. The incidence rates of aspiration and feeding tube displacement were significantly higher in the bolus orogastric tube group compared with the bolus nasogastric tube group. There was no difference in the incidence rates of apnea, necrotizing enterocolitis, bradycardia, oxygen desaturation, and gastric residual in both groups. Conclusion Preterm infants without any respiratory support receiving bolus nasogastric tube feeding achieved full enteral feeding significantly sooner than those receiving bolus orogastric tube feeding. Additionally, bolus nasogastric tube feeding had a lower incidence of aspiration, tube displacement, and the infants regained birthweight more quickly than those receiving orogastric tube feeding. Key Points

Prognostic value of nutritional status for esophageal cancer patients undergoing neoadjuvant therapy and resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 133-133 ◽  
Author(s):  
Sabrina D Saeed ◽  
Jacques Fontaine ◽  
Luis Pena ◽  
Sarah E. Hoffe ◽  
Jessica Frakes ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Prognostic Value ◽  
Feeding Tube ◽  
Tube Placement ◽  
Significant Weight Loss ◽  
Increased Risk ◽  
The Impact

133 Background: Malnutrition, linked to decreased patient tolerance to chemotherapy and increased rates of therapy-related toxicity, negatively affects cancer prognosis. Esophageal carcinomas (EC) frequently present with dysphagia and significant weight loss which may be exacerbated by neoadjuvant chemoradiation, placing EC patients at an increased risk of malnutrition. We therefore aim to assess the prognostic value of pre-operative malnutrition for esophageal cancer patients undergoing neoadjuvant therapy (NAT). Methods: Query of our institution’s IRB approved database of 1113 EC patients (pts) identified 725 individuals who underwent NAT followed by resection from 1994-2018. Seventy-six pts were considered to be at higher nutritional risk during NAT, as indicated by significant weight loss and enteral feeding tube requirement (ETF+), while 644 did not receive pre-operative feeding tube placement (ETF–). Clinicopathologic characteristics, post-operative outcomes, and survival were compared between ETF+ and ETF– using various statistical methods. Results: Of the included pts, 83% were male with a median age of 64.5 (28-86) years. Between ETF+ (n = 76) and ETF– (n = 644), pt characteristics were balanced in terms of initial stage, age, histology and tumor location. A higher percentage of ETF+ pts had > 5% weight loss before NAT (32 vs. 6%; p < .01). ETF+ was associated with a significantly worse median survival (27 vs. 77 m; p < .01), but not with increased post-operative length of hospital stay (p = .69), complications (p = .20) or tumor recurrence (p = .89). Although completion of chemotherapy (p = .46) and radiation (p = .49) were comparable between ETF+ and ETF–, tumor response was worse in the ETF+ group (71 vs. 60% non-complete response; p = .02). Conclusions: Our results suggest that baseline malnutrition is a risk factor for poor survival and negatively impacts the efficacy of neoadjuvant therapy in EC patients. Poor response to NAT in malnourished patients may stem from impaired immune function. Future prospective studies should evaluate other parameters for nutritional assessment to further assess the impact of malnutrition on tumor regression and survival after NAT.

The impact of different medical complications on the feasibility of removing the feeding tube from infants with dysphagia

2021 ◽  
Vol 14 (3) ◽  
pp. 371-377
Author(s):  
Hikari Fukatsu ◽  
Kanji Nohara ◽  
Nobukazu Tanaka ◽  
Nami Fujii ◽  
Takayoshi Sakai
Keyword(s):  
Tube Feeding ◽  
Feeding Tube ◽  
Cardiovascular Complications ◽  
Oral Feeding ◽  
Medical Complications ◽  
Cardiac Complications ◽  
Medical Complication ◽  
Feeding Tubes ◽  
Tube Removal ◽  
The Impact

PURPOSE: This study examined whether certain medical complications influence the feasibility of tube removal. METHODS: 42 subjects with dysphagia who were under the age of 2.5 years were nourished entirely through feeding tubes. Additionally, they were judged to have no aspiration. The following data about the infants were collected through a retroactive survey: age at which oral feeding training commenced, gender, and whether certain medical complications (cardiovascular, respiratory, digestive, neurological, or oral) had been present at birth. The data were analyzed to determine which type of medical complication affected the likelihood of removing the feeding tube from the infant at 3 years of age. RESULTS: Of the five medical complications examined, cardiovascular complications significantly affected the feasibility of tube removal (p = 0.049). CONCLUSION: Pediatric dysphagia patients with cardiac complications, compared to those with other complications, may take longer to transition off tube feeding.

The impact of HPV status on weight loss and feeding tube use in oropharyngeal carcinoma

Oral Oncology ◽  
2018 ◽  
Vol 79 ◽  
pp. 33-39 ◽  
Author(s):  
Belinda Vangelov ◽  
Damian P. Kotevski ◽  
Janet R. Williams ◽  
Robert I. Smee
Keyword(s):  
Weight Loss ◽  
Feeding Tube ◽  
Oropharyngeal Carcinoma ◽  
Hpv Status ◽  
The Impact

Gastroenterology

2012 ◽  
pp. 351-382
Author(s):  
Lesley K Bowker ◽  
James D Price ◽  
Sarah C Smith
Keyword(s):  
Weight Loss ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Enteral Feeding ◽  
Older Patients ◽  
The Elderly ◽  
Feeding Tube ◽  
Gastrointestinal System ◽  
P Nutrition ◽  
Ulcer Disease

The ageing gastrointestinal system 352 The elderly mouth 354 Nutrition 356 HOW TO . . . Manage weight loss in older patients 357 Enteral feeding 358 HOW TO . . . Insert a fine-bore NG feeding tube 359 The ethics of clinically assisted feeding 360 Oesophageal disease 362 Dysphagia 364 Peptic ulcer disease ...

Percutaneous Enteral Feeding in Patients With 22q11.2 Deletion Syndrome

2021 ◽  
pp. 105566562199611
Author(s):  
Bridget Ebert ◽  
Noelle Morrell ◽  
Hanan Zavala ◽  
Sivakumar Chinnadurai ◽  
Robert Tibesar ◽  
...  
Keyword(s):  
Enteral Feeding ◽  
Tube Feeding ◽  
Retrospective Chart Review ◽  
22Q11.2 Deletion Syndrome ◽  
Feeding Tube ◽  
Subglottic Stenosis ◽  
Tube Placement ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Feeding Tube Placement

Objective: To describe the incidence of percutaneous enteral feeding in patients with 22q11.2 deletion syndrome (22q11.2 DS) and determine factors associated with the need for percutaneous enteral feeding tube placement. Design: Retrospective chart review. Methods: The records of a 22q11.2 DS clinic and pediatric otolaryngology clinic at a tertiary pediatric hospital were reviewed from January 1, 2009, to December 31, 2019. All patients with confirmed 22q11.2 deletion were identified. Cardiac, otolaryngological, and feeding characteristics were recorded along with surgical history. A patient was defined to have a G-tube if the history was significant for any percutaneous gastric feeding tube placement, including a gastrostomy tube, gastrostomyjejunostomy tube, or a Mickey button. Results: One hundred ninety patients with confirmed 22q11.2 DS by genetic testing were included. Thirty-three percent (n = 63) required G-tube placement. G-tube placement was associated with cardiac diagnosis ( P < .01), history of cardiac surgery ( P < .01), aspiration ( P < .01), nasopharyngeal reflux ( P < .01), subglottic stenosis ( P < .01), laryngeal web ( P = .003), and tracheostomy ( P < .01). This suggests these conditions are associated with higher rates of G-tube placement in the 22q11.2 DS population. Conclusions: Patients with 22q11.2 DS often require supplemental nutritional support in the form of G-tube feeding, most often in the first year of life. Congenital heart abnormalities and surgery along with tracheostomy, subglottic stenosis, laryngeal web, aspiration, and nasopharyngeal reflux are significantly associated with the need for G-tube placement. Understanding associations between comorbid conditions and G-tube placement, especially those involving the head and neck, may assist with counseling of patients with 22q11.2 DS.

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