Percutaneous Endoscopic Gastrostomy in Neurological Patients

Patients with neurologic dysfunction are at increased risk for malnutrition due to a combination of cognitive, behavioral and mechanical problems. Cohort studies have shown that 20-50% of hospital patients are malnourished (McWhirter & Pennington, 1994; Norman et al., 2008; Kurien et al., 2010), and 20-40% of critically ill patients show evidence of proteinenergy malnutrition (Ziegler, 2009). Access for supplemental nutrition may be considered to meet the nutritional needs of any patient with a functional gastrointestinal tract who is unable to safely swallow (Kulick & Deen, 2011; McClave et al., 2009). The primary aim of enteral tube feeding is to avoid further loss of body weight, to correct significant nutritional deficiencies, to rehydrate the patient, to promote growth in children with growth retardation, and to stop the related deterioration of the quality of life of the patient due to inadequate oral nutrition intake (Loser et al., 2005). A variety of enteric feeding tube options exist, including endoscopically-placed nasogastric feeding tubes, percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG), and per-oral image guided gastrostomy (PIG) (Laasch et al., 2003; Hoffer et al., 1999; Preshaw, 1981; Tao & Gillies, 1983; Wills & Oglesby, 1983; Gauderer et al., 1980). The endoscopic access routes have been more popular than radiologic routes, which despite being quite effective have been reserved as a PEG alternative in cases deemed too risky or difficult for the passage of an endoscope (de Baere et al., 1999; Galaski et al., 2009; Loser et al., 2005; Ozmen & Akhan, 2002). Enteral access can also be obtained surgically, but this has become much less frequent since the advent of these less-invasive techniques (Duszak & Mabry, 2003; Sleisenger et al., 2010). In cases where endoscopic access is not obtained, technical considerations and/or local availability play a role in determining whether a patient receives a radiological or surgical gastrostomy (Kurien et al., 2010; Leeds et al., 2010; Ljungdahl & Sundbom, 2006).