RANDOMIZED PROSPECTIVE TRIAL OF EARLY VERSUS DELAYED FEEDING AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY PLACEMENT

Objective: By convention, most clinicians delay feeding through the ga strostomy tube until 24 h after placement. However, evidence is lackin g to support the rationale for such a delay in PEG use. This randomize d, prospective study was designed to assess the safety of early feedin g after PEG placement. Methods: One hundred-twelve patients referred f or PEG were randomized to begin tube feedings at 4 h (group ii) or at 24 h (group B) after placement. All patients received prophylactic ant ibiotics. Full-strength Isocal was administered with the following sch edule: day 1, 100 mi every 4 h for six feedings; day 2, 200 mi every 4 h for six feedings. Immediately before each scheduled feeding, gastri c residual volume was recorded and the next feeding was withheld if th e residual volume was > 50 percent (gastric retention). Patients were evaluated on day 1, day 2, day 7, and day 30 for major and minor compl ications. Results: The two groups were similar with regard to age, gen der, baseline nutritional status, and indications for PEG placement. O n the first day of feeding, 14 of 57 patients (25%) in group A, but on ly five of 55 patients (9%) in group B, had evidence of gastric retent ion, p = 0.029. The proportion of patients with high gastric residual volumes was not significantly different on day two. In group B, one de ath occurred because of aspiration of gastric contents on day 2. All o ther complications were minor and did not differ significantly between the two groups. Conclusions: Early initiation of PEG feedings is safe , well tolerated, and reduces cost by decreasing hospital stay. (C) 19 98 by Am. Cell. of Gastroenterology.