Percutaneous endoscopic gastrostomy feeding in patients withcystic fibrosis

Background—Malnutritionis a common management problem in patients with cystic fibrosis (CF).Various approaches to supplemental nutrition by both parenteral andenteral routes have been used.
Aim—To analyse theefficacy and acceptability of supplemental overnight feeding using apercutaneous endoscopic gastrostomy (PEG) in patients with CF.
Patients—53 patientswith CF (43 adults; age >17 years) with severe pulmonary disease.
Methods—The technicalsuccess and complications of PEG insertion were documented togetherwith changes in nutritional and pulmonary status of the cohort.
Results—PEGtubes were successfully inserted in all patients, with immediatecomplications (respiratory depression) in two (4%) and latecomplications in 13 (25%). Feeding was well tolerated by 50/51 (98%)of the cohort during a mean (SEM) follow up of 14.5 (2.1) months. Theadult cohort had a significant increase in weight and body mass indexat six months which was maintained at 12 months. Serum albuminconcentration remained stable at six months but had fallen by 12 months, although the differences were not statisticallysignificant. These results were reflected in the paediatric cohort.Pulmonary function in those followed up for one year had apparentlystabilised, but the number of admissions to hospital over the yearbefore and the year after PEG did not change. Half of the cohort wereaccepted for heart-lung/lung transplantation, the improvement innutritional status being a prerequisite for this.
Conclusion—SupplementalPEG tube feeding is well tolerated and results in a significantimprovement in nutritional status and an apparent stabilisation ofpulmonary function in severely malnourished CF patients with advancedpulmonary disease.

Keywords:cystic fibrosis; malnutrition; enteral nutrition; percutaneous endoscopic gastrostomy