Percutaneous endoscopic gastrostomy feeding in patients with cystic fibrosis

S G J Williams,^a F Ashworth,^b A McAlweenie,^b S Poole,^b M E Hodson,^b D Westaby^a

^a Department of Gastroenterology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10, UK, ^b Department of Cystic Fibrosis, The Royal Brompton Hospital, Sydney Street, London SW3

Correspondence to: Dr D Westaby.

Accepted for publication 22 July 1998

BackgroundMalnutrition is a common management problem in patients with cystic fibrosis (CF). Various approaches to supplemental nutrition by both parenteral and enteral routes have been used.
AimTo analyse the efficacy and acceptability of supplemental overnight feeding using a percutaneous endoscopic gastrostomy (PEG) in patients with CF.
Patients53 patients with CF (43 adults; age >17 years) with severe pulmonary disease.
MethodsThe technical success and complications of PEG insertion were documented together with changes in nutritional and pulmonary status of the cohort.
ResultsPEG tubes were successfully inserted in all patients, with immediate complications (respiratory depression) in two (4%) and late complications 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. The adult cohort had a significant increase in weight and body mass index at six months which was maintained at 12 months. Serum albumin concentration remained stable at six months but had fallen by 12 months, although the differences were not statistically significant. These results were reflected in the paediatric cohort. Pulmonary function in those followed up for one year had apparently stabilised, but the number of admissions to hospital over the year before and the year after PEG did not change. Half of the cohort were accepted for heart-lung/lung transplantation, the improvement in nutritional status being a prerequisite for this.
ConclusionSupplemental PEG tube feeding is well tolerated and results in a significant improvement in nutritional status and an apparent stabilisation of pulmonary function in severely malnourished CF patients with advanced pulmonary disease.
(GUT 1998;44:87-90)

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