Effect of Body Mass Index on Processing Time and Morbidity in Elderly Percutaneous Endoscopic Gastrostomy Patient

CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory parameters were roughly stable 1 and 3 months after the gastrostomy procedure. CONCLUSIONS: In patients with advanced upper esophageal cancer where only palliative treatment is possible, nutritional support is easily achieved with percutaneous endoscopic gastrostomy, allowing patients to be at homes, surviving a significant period of time. Percutaneous endoscopic gastrostomy feeding should be considered as standard definitive nutritional palliation in patients with upper esophageal cancer, unsuitable for esophageal stenting.

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Percutaneous endoscopic gastrostomy in comprehensive preparing the patients with severe body mass defciency for lung transplantation

Transplantologiya The Russian Journal of Transplantation ◽

10.23873/2074-0506-2019-11-1-55-60 ◽

2019 ◽

Vol 11 (1) ◽

pp. 55-60

Author(s):

M. Sh. Khubutiya ◽

A. M. Gasanov ◽

E. A. Tarabrin ◽

T. E. Kallagov ◽

E. I. Pervakova ◽

...

Keyword(s):

Body Mass Index ◽

Cystic Fibrosis ◽

Enteral Nutrition ◽

Lung Transplantation ◽

Body Mass ◽

Percutaneous Endoscopic Gastrostomy ◽

Lung Diseases ◽

Comparison Group ◽

Waiting List ◽

Endoscopic Gastrostomy

Introduction. Currently, lung transplantation is an approved method for treating a wide range of end-stage lung diseases refractory to medical or surgical treatments when patient's life expectancy without transplantation makes no more than two years.The aim was to evaluate the efficacy of continuous nutritional support via percutaneous endoscopic gastrostomy in potential recipients of lung transplantation with a Body Mass Index under 16 kg/m2.Material and methods. The study was based on the analysis of 93 potential recipients with various lung diseases; 27 of them with diagnosed cystic fibrosis. The enteral nutrition results of the patients with cystic fibrosis whose Body Mass Index (BMI) was under 16 kg/m2 were assessed by the increment in BMI and compared between those (15) fed via gastrosomy and those (22) fed per os.Results. As a result of enteral nutrition via the gastrostomy in the daytime and at night, the majority of recipients (73.3% of cases) had the Body Mass Index (BMI) corrected from 0.1 to 4.91 kg/m2 during the first year, the mean BMI increment made 1.87 ± 0.4 kg/m2. After the BMI correction, 11 of the 15 potential recipients were included in the waiting list, and 6 of them (40%) underwent lung transplantation. In the comparison group, the BMI increment was 0.9 ± 0.3 kg/m2, also having reached a significant difference compared to the baseline (p = 0.04). However, the BMI increment in the main group was significantly higher than in the comparison group (p = 0.02).Conclusion. A statistically significant increase in BMI in a group of patients with cystic fibrosis and BMI under 16 kg/m2, has been demonstrated after percutaneous endoscopic gastrostomy, which allows extending the criteria for the inclusion in the waiting list for lung transplantation.

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Feasibility of assessing patient health benefits and incurred costs resulting from early dysphagia intervention during and immediately after chemoradiotherapy for head-and-neck cancer

Current Oncology ◽

10.3747/co.24.3543 ◽

2017 ◽

Vol 24 (6) ◽

pp. 466 ◽

Cited By ~ 5

Author(s):

R. Martino ◽

J. Ringash ◽

L. Durkin ◽

E. Greco ◽

S. Hui Huang ◽

...

Keyword(s):

Body Mass Index ◽

Head And Neck Cancer ◽

Head And Neck ◽

Body Mass ◽

Neck Cancer ◽

Swallowing Function ◽

Endoscopic Gastrostomy ◽

Patient Health ◽

Accrual Rate ◽

Related Quality

Background Resource limitations affect the intensity of speech–language pathology (slp) dysphagia interventions for patients with head-and-neck cancer (hnc). The objective of the present study was to assess the feasibility of a prospective clinical trial that would evaluate the effects on health and patient costs of early slp dysphagia interventionfor hnc patients planned for curative concurrent chemoradiotherapy (ccrt).Methods Patients with hnc planned for curative ccrt were consecutively recruited and received dysphagia-specific intervention before, during, and for 3 months after treatment. Swallowing function, body mass index, health-related quality of life (qol), and out-of-pocket costs were measured before ccrt, at weeks 2 and 5 during ccrt, and at 1 and 3 months after ccrt. Actuarial percutaneous endoscopic gastrostomy (peg) removal rates and body mass index in the study patients and in a time-, age-, and disease-matched cohort were compared.Results The study enrolled 21 patients (mean age: 54 years; 19 men). The study was feasible, having a 95% accrual rate, 10% attrition, and near completion of all outcomes. Compared with the control cohort, patients receiving dysphagia intervention trended toward a higher rate of peg removal at 3 months after ccrt [61% (32%–78%) vs. 53% (23%–71%), p = 0.23]. During ccrt, monthly pharmaceutical costs ranged between $239 and $348, with work loss in the range of 18–30 days for patients and 8–12 days for caregivers.Conclusions We demonstrated the feasibility of comparing health and economic outcomes in patients receiving and not receiving early slp dysphagia intervention. These preliminary findings suggest that early slp dysphagia intervention for hnc patients might reduce peg dependency despite worsening health. Findings also highlight effects on financial security for these patients and their caregivers.

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