P-OGC43 Morbidity and unplanned hospital attendance among patients with oesophagogastric cancer treated with home enteral nutrition

Background Nutritional optimisation is an essential component of prehabilitation and enhanced recovery for patients with oesophageal and gastric cancer, but may be associated with increased burden of inpatient care. The aim of this study was to determine risk factors associated with complications and unplanned hospital attendance among patients treated with home enteral nutrition. Methods Consecutive patients with oesophageal or gastric cancer commencing home enteral nutrition from March 2020-June 2021 were prospectively studied. The primary outcome measure was the incidence of complications associated with home enteral feeding requiring unplanned hospital attendance. Univariable and multivariable linear and logistic regression were used to determine factors independently associated with enteral feeding associated morbidity and healthcare utilisation. Results 70 patients were studied (27% pre neoadjuvant therapy, 63% postoperative; 19% gastrostomy, 81% jejunostomy). Tube complications requiring unplanned hospital attendance occurred in 33% of patients (25% gastrostomy, 38% jejunostomy, P = 0.405), most commonly dislodgement (15%), fixation problem (13%), and blockage (6%). Small bowel obstruction was rare (1.4%). Inpatient length of stay (LOS) following feeding tube placement and training was 5.1±2.4 days (gastrostomy: 5.5±2.7, jejunostomy: 4.4±1.9 days, P = 0.074). 17 unplanned hospital visits among nine patients (13.0%) occurred with a cumulative LOS of 71 inpatient days. On multivariable analysis patients undergoing neoadjuvant therapy were at the greatest risk of overall enteral feeding tube morbidity (OR19.34 [3.29–113.56], P = 0.001), dislodgement (OR19.09 [2.35-155.11], P = 0.006) and unplanned hospital attendance (P < 0.001). Older patients were at increased risk of tube dislodgement (OR1.14 [1.02–1.28], P=0.024) and unplanned hospital attendance (P = 0.034). Conclusions Unplanned hospital attendance is common among patients undergoing supplemental home enteral nutrition during treatment for oesophagogastric cancer. Fixation problems and dislodgement account for the majority of presentations, and are more common among older patients and those undergoing neoadjuvant therapy. Pragmatic strategies to optimise tube fixation and minimise the need for unplanned hospital visits among patients receiving home enteral nutrition are urgently needed.

Home Enteral Nutrition in Adults: Effectiveness of Nutritional Therapy and Educational Programme

PurposeHome Enteral Nutrition (HEN) is used to prevent or correct malnutrition in outpatients. Due to the complexity of this process, the indication, follow-up, and results of an educational programme of HEN patients was evaluated.MethodsA prospective, observational, real-life, multicentre study of patients receiving HEN by nasogastric tube or ostomy in 21 hospitals was conducted. The following variables were collected: age, gender, HEN indication, type of formula, nutritional requirements, laboratory variables, complications, and quality standards of the educational programme. All data were analysed using SPSS.24.Results414 patients were included. Most conditions diagnosed were neurodegenerative diseases (64.8%). 100 patients (25.3%) were diabetic. The mean weight was 59.3±10.4kg and BMI 22.6±3.2. Moderate protein-calorie malnutrition was predominant at baseline (46.4%). Improvement in nutritional status at six months was recorded in more than 75% of patients (p<0.05). Tolerance problems, diarrhoea and abdominal distension fell between the 3- and 6-month visits (p <0.05). Patients who received intermittent Enteral Nutrition (EN) had fewer tolerance-related effects (OR: 0.042; 95% CI: 0.006-0.279) and less diarrhoea (OR: 0.042; 95% CI: 0.006-0.279), while those who received EN via nasogastric tube had fewer tolerance-related effects (OR: 0.042; 95% CI: 0.006-0.279). At the baseline and 6-month visits, compliance with the educational measures proposed by the prescriber was ≥ 99%. ConclusionThe nutritional assessment to prescribe individualised HEN to each patient, together with educational measures and training in the proper use of this treatment for both patients and trainers, improves nutritional status and reduces the onset of adverse reactions.