The safe use of percutaneous gastrostomy for enteral nutrition in patientswith Crohn's disease

Objective To determine the safety of percutaneous endoscopic gastrostomy (P EG) tube placement for nutritional support and/or defined therapeutic enter al nutrition (TEN) in adult patients with Crohn's disease. Design A prospective, observational study of patients with Crohn's disease in whom PEG tubes were placed for nutritional support or TEN. Setting A specialist nutrition clinic at a gastroenterology tertiary referr al centre in Harrow, UK. Participants Nine patients with Crohn's disease. Seven patients had nutriti onal failure and were unable to tolerate nasogastric feeding, and two patie nts were recruited in whom TEN therapy for active disease was indicated. Th e age range was 21-52 years (median, 30 years). Five patients were female; all had had previous ileo-colonic resections, one had a gastro-enterostomy and one had a non-healing Crohn's-related gastric ulcer. Interventions PEG insertion (Fresenius, Frecka 9 Fr) was performed at endos copy with intravenous sedation. Follow-up with tubes in situ was for a medi an of 37 weeks (range, 4-276 weeks), and for a further median of 80 weeks ( range, 52-120 weeks) in those whose tubes have been removed. Main outcome measures The level of disease activity, nutritional status/bod y mass index and any complications associated with PEG tube placement were recorded. Results PEG was achieved in all patients; the only complication was a minor superficial entry site infection. Five patients continue to use PEG feedin g to good effect, including healing of the Crohn's-associated ulcer. One pa tient now eats normally having regained target weight, and three require pa renteral nutrition, having failed to achieve nutritional sufficiency despit e an optimal enteral regimen via the PEG. An adverse body image in one of t hese patients (an opiate abuser with a long psychiatric history) was probab ly contributory to PEG failure. There was no peristomal or fistulous diseas e. Conclusions Although nutrition via PEG is not always successful, failures a re of enteral nutrition, and not of the means. PEG use in selected patients with Crohn's disease appears safe and can prove a useful addition to thera peutic options. (C) 2000 Lippincott Williams & Wilkins.