Early initiation of tube feeding after percutaneous gastrostomy in inpatients – a prospective pilot study.

Many interventional radiology have patients fast for 12-24 hours after gastrostomy placement to prevent complications. However, randomized-controlled trials support safety of early feeding after endoscopic gastrostomy {1}. A retrospective study deemed early feeding safe after image-guided gastrostomy placement with pigtail catheters {2}. The purpose of this study is to prospectively evaluate safety of an early feeding protocol after image-guided percutaneous gastrostomy with balloon-retained tubes.

Materials and Methods:

Between July 1^st, 2021, and September 21^st, 2022, 24 consecutive patients who underwent image-guided percutaneous gastrostomy tube placement from a neurovascular unit at a tertiary care academic hospital were prospectively enrolled in a protocol of early initiation of feeding. All patients had history of recent cerebrovascular accident and dysphagia requiring long term enteral access. Patients underwent fluoroscopy-guided percutaneous placement of a push type gastrostomy tube by Interventional Radiology.  Three hours after placement, each patient was assessed by their floor registered nurse for signs and symptoms of peritonitis and other complications such as tube dislodgement or bleeding. Once deemed appropriate by the nurse, tube feeds were initiated with clinical monitoring. Early initiation of tube feeds was defined as initiation within 12 hours after placement. Follow-up information was obtained by two clinical nutritionists within 72 hours after discharge to assess for tube feeding tolerance and late complications.

Results:

Technical success for the placement of the gastrostomy tube was 100%. At 3 hours post procedure, all patients were deemed appropriate for early initiation of tube feeding. All patients had tube feeds initiated within 12 hours of placement with average time from placement to initiation of 4.4 hours. No patients experienced complications that required termination of early feeds. Average time from gastrostomy placement to discharge was 8.7 days. No delays in discharge were related to gastrostomy tube place and feeding.  72 hours after discharge, all patients were tolerating tube feeds. No major early or late complications were identified.

Conclusion: Preliminary results of this pilot protocol demonstrate that early tube feeding after uncomplicated image-guided percutaneous gastrostomy tube placement is safe for inpatients with a recent cerebrovascular accident. Early tube feeding decreases fasting time and may decrease overall length of hospital stay.