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ENTERAL NUTRITION / ACCESS
1) R-220: Clinical trials of an infant tube feeding formula in enterally fed patients in a hospital setting. Celeste C. Tanchoco (1*), Milagros F. Villadolid (1), Marietta P. Rodriguez (1), Marietta B. Pangan (1), Judaline S. Robles (1), Ida Marie M. Tabangay (2), Marie France G. Dado (3), and Joan Marie P. Sumpio (3). (1) Clinical Nutrition Section, Medical Nutrition Division, Food and Nutrition Research Institute – Department of Science and Technology; (2) Department of Surgery, Clinical Division, Santo Tomas University Hospital; (3) Dietary Department, Santo Tomas University Hospital
2) R-419: PEG indications, complications, and effect on nutritional status on elderly patients in a tertiary care hospital in the Philippines from January to December 2004. Jiloca JL (1), Ramos MA (1), Llido LO (2). (1) Geriatric Center and (2) Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
3) R-487: Clinical Outcomes Of Transnasal Endoscopic Placement Of Naso-Enteric Feeding Tubes In Non-Icu Patients. Sanjiv Mahadeva, Ida Hilmi, Chin-Jou Chua, Abdul Malik, Choon-Heng Wong, Choon-Seng Qua, Khean-Lee Goh. Division of Gastroenterology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
ENTERAL AND PARENTERAL NUTRITION (top)
R - 353: Comparison of early enteral nutrition and total parenteral nutrition after total gastrectomy
Hee Kwon1, Jong Hee Ko1, Ji Hyune Ahn1, Eun Sun Son1, Sung Eun Song2, Eun Joo Lee2, Ho Sun Lee2, Mi Hwa Cho3, Jeong Ae Kang3, Hye Sun Shin4, Seok Jun Yoon5, Ho Young Yoon5, Choong-Bai Kim5
1Division of Pharmacy, 2 Department of Dietitis, 3Division of Nursing, 4Home Health Care Center, 5Department of Surgery, Yonsei University Health System, Seoul, Korea
ABSTRACTS OF POSTER PRESENTATION
R –220 * (top) / Oral presentation
Clinical trials of an instant tube feeding formula in enterally fed patients in a hospital setting
Celeste C. Tanchoco(1)*, Milagros F. Villadolid(1), Marietta P. Rodriguez(1), Marietta B. Pangan(1), Judaline S. Robles(1), Ida Marie M. Tabangay(2), Marie France G. Dado(3), and Joan Marie P. Sumpio(3)
(1) Clinical Nutrition Section, Medical Nutrition Division, Food and Nutrition Research Institute, Department of Science and Technology; (2) Department of Surgery, Clinical Division, Santo Tomas University Hospital; (3) Dietary Department, Santo Tomas University Hospital
Background/Objective(s): The instant tube feeding formula developed by the Food and Nutrition Research Institute was clinically tested among 14 tube-fed patients, confi ned at the Santo Tomas University Hospital to determine its effi cacy, suitability, acceptability and safety as a source of nutritional support.
Methodology: Each patient received the reconstituted tube feeding formula during the clinical trial period of two weeks. Evaluation of dietary intake, anthropometric measurements, biochemical analyses and diet tolerance were undertaken to provide information about the response to treatment. Microbiological examinations were done on 13 formulas prepared in the hospital.
Results: The study showed that the formula can prevent signifi cant nutritional deterioration in most tube-fed patients. In terms of nutrient density, the formula was found to be comparable to a commercial formula. The formulas provided fair to more than adequate amounts of protein, calcium, iron and the major vitamins except niacin and vitamin C. The high microbiological susceptibility of blenderized diets were also observed. Excellent tolerance of the formula was noted favoring recommendation of its use as a means of nutritional support.
R – 419 * (top) / Oral presentation
Percutaneous Endoscopic Gastrostomy (PEG) indications, complications, and effect on nutritional status on elderly patients in a tertiary care hospital in the Philippines from January to December 2004
Jiloca JL 1, Ramos MA 1, Llido LO 2 1 Geriatric Center and 2 Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
Background/Objective(s): Percutaneous endoscopic gastrostomy (PEG) is widely used for pediatric and adult patients with inadequate oral intake, but few studies evaluated its value in the elderly patients as to tolerance and nutritional status. This study analyzes the profi le of geriatric patients with PEG in our institution and correlates PEG with the indications, complications, and patient nutritional status.
Methods: Admitted geriatric patients with PEG were followed up during the months of January to December 2004. The patient profi le, medical condition, co-morbidities, indication(s), complication(s), and follow up nutritional status (BMI) after PEG were gathered.
Results: 44 geriatric patients with PEG were collected from 117 cases of PEG inserted patients admitted in year 2004. The median age is 84 years (range 60 to 101 years), 21 males and 23 females. The main conditions when PEG was inserted were: gastrointestinal (26%), neurological (24%), cardiovascular (14%), and infectious (14%). Follow up was within 6 months (52%) to one year (48%). Follow up BMI showed nutritional status to be: normal (52.3%), overweight (22.7%), underweight (18.2%), and obese (6.8%). Most of the underweight were from the 80 to 89 year old age group (28.6%). Adequate intake as shown by the nutritional status was achieved in 81.8% (p<0.05) of patients. Complication rate was 14% (wound infection 4.3%, diarrhea 3.4%, aspiration 2.6%, and vomiting 1.7%). The mortality of 9% was not associated with PEG status, but with the disease process.
Conclusion: PEG improves intake and subsequent nutritional status in 81.8% of admitted geriatric patients. Complication rate was minimal with no associated mortality.
R - 487 (top)
Clinical Outcomes Of Transnasal Endoscopic Placement Of Naso-Enteric Feeding Tubes In Non-Icu Patients
Sanjiv Mahadeva, Ida Hilmi, Chin-Jou Chua, Abdul Malik, Choon-Heng Wong, Choon-Seng Qua, Khean-Lee Goh
Division of Gastroenterology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Background/ Objective: Placement of nasoenteric feeding tubes are notoriously diffi cult or cumbersome. Recent reports of a novel endoscopic placement method using a transnasal approach has shown promise. We report our experience with this method in non-ICU patients.
Methods: All cases referred to this unit for nasoenteric placement were prospectively reviewed. Transnasal endoscopy was performed using an ultra-thin Olympus GIF-XP 160 gastroscope and a guide-wire passed through the scope into the duodenum. A 10 Fr naso-jejunal (NJ) tube was then placed directly into the small intestine over the guide wire. All tube positions were checked by fl uoroscopy.
Results: Between January 2005 and May 2006, 22 patients (median age 62.5 years; range 20 – 83) were referred for NJ tube placement. Indications were as follows: Gastroparesis n=4, duodenal stenosis n=3, persistent gastro-cutaneous fi stulae n=6, aspiration post surgery n=1, pancreatitis n=3. Placement of NJ tubes beyond the duodenum was successful in 19/ 22 (86.3%). Failure of placement occurred in 2 cases of malignant duodenal stenosis and one patient with a gastro-cutaneous fi stula. NJ tubes were held in place for a median time of 24 days (range 2 – 94), where placement was successful. Outcomes of the NJ feeding were as follows: complete healing of 5/6 gastrocutaneous fi stulae, successful establishment of feeding in all cases of pancreatitis, gastroparesis and 1/3 patients with duodenal stenosis.
Conclusion: Transnasal endoscopic placement of NJ tubes is an effective method for establishing enteral feeding in non-ICU patients. Our
experience suggests that the indications can be quite varied, although cases of duodenal stenosis remain a technical challenge
R - 353 (top)
Comparison of early enteral nutrition and total parenteral nutrition after total gastrectomy
Hee Kwon1, Jong Hee Ko1, Ji Hyune Ahn1, Eun Sun Son1, Sung Eun Song2, Eun Joo Lee2, Ho Sun Lee2, Mi Hwa Cho3, Jeong Ae Kang3, Hye Sun Shin4, Seok Jun Yoon5, Ho Young Yoon5, Choong-Bai Kim5
1Division of Pharmacy, 2 Department of Dietitis, 3Division of Nursing, 4Home Health Care Center, 5Department of Surgery, Yonsei University Health System, Seoul, Korea
Objectives: To compare evaluation of nutritional parameter, immune competency, and incidence of complications between early enteral nutrition (EN) and total parenteral nutrition (TPN) after total gastrectomy.
Methods: Patients were prospectively randomized to receive early EN by nasoenteral tube (n=17) or TPN by central venous catheter (n=16) after total gastrectomy in Yonsei University Health System from March 2006 to July 2007. The nutritional goals were 25kcal/kg/day for total daily calories and 1.5g/kg/day for total daily protein. Early EN group was defi ned as enteral nutritional supply within 8 hours after total gastrectomy. EN was started from 400-500ml (400-500kcal), titrating up every day and insuffi cient calories and protein was compensated with peripheral parenteral nutrition (PPN). TPN group was defi ned as nutrirional supply with TPN from POD 1 to POD 5. Postgastrectomy (PG) liquid diet and PG soft diet were started on POD 6 to 7 in both groups. All nutritional parameters including weight change, total protein, albumin, prealbumin, transferrin, total lymphocyte count, liver function test, and length of hospital stay were compared and measured on before surgery and POD 7.
Results: There were no signifi cant differences in baseline characteristics between two groups. After total gastrectomy, no signifi cant differences were found in laboratory parameters (weight change, AST/ALT, total protein, albumin, prealbumin, transferrin, total lymphocyte count) and length of hospital stay. But, AST/ALT elevated within the TPN group slightly in POD 7. There were no infectious complications in both groups. Early EN group had GI complications such as nausea, vomiting, abdominal distension and increased AST/ALT values. TPN group had increased total bilirubin, ASL/ALT values.
Conclusion: Considering the fact that both groups showed small decease in weight, active nutritional support is essential in patients with
total gastrectomy. There were no statistically signifi cant differences between early EN and TPN group in nutritional parameters and immune competency after total gastrectomy. Based on this result, both early EN and TPN seem to be appropriate in supplying nutrition after total gastrectomy.