tions related to their feeding tube. Of those the most common complications reported were with NGTs. 5 patients (29%) had tubes replaced due to blockage or ...
Abstracts Abstract PWE-225 Table 1
Type and duration of feeding tube
Type of feeding tube
No. (%)
Duration of feeding (days)
No. (%)
NG
16 (94)
< 10
1 (6)
RIG
1 (6)
10–29s
5 (29)
30–89
8 (47)
‡90
3 (18)
All the 11 patients fed for >30 days started with a NGT. 3 were eventually converted to gastrostomies, 4 were clinically unwell and never stable enough to be considered for a gastrostomy, for 1 patient gastrostomy insertion was contraindicated and 3 patients were predicted to respond sooner to treatment and resume oral intake. 10 (59%) patients experienced complications related to their feeding tube. Of those the most common complications reported were with NGTs. 5 patients (29%) had tubes replaced due to blockage or accidental falling out and 3 patients (18%) had repeated difficulties obtaining aspirates or pH of aspirates 30 days. It may be more appropriate to consider a gastrostomy insertion for those feeding medium to long term as these are commonly associated with less complications.2 We encounter repeated problems with blocked NGTs and difficulties with obtaining gastric aspirates. We therefore need to review our practices in terms of information, training and ongoing support provided to patients in order to reduce these types of complications. Disclosure of interest None Declared. REFERENCES 1 2
Arends J, et al. ESPEN Guidelines on Enteral Nutrition: Non surgical oncology. Clin Nutr. 2006;25:245–259. Gomes J, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. The Cochrane Library, Issue 11, 2011.
pathway. The main indication for EN was dysphagia secondary to disease (76%), oesophagitis secondary to radiotherapy (12%), inadequate oral intake (6%) and tracheal-oesophageal fistula (6%). 12 patients were nil by mouth due to aspiration risk and 5 were managing < 60% of estimated nutritional requirements. Only 3 (18%) patients were given a predicted prognosis of 3 months in all but 3 patients. However, the effectiveness of EN is rarely recorded and greater consideration should be given to validated outcome measures both in terms of anthropometry and QOL. Disclosure of interest None Declared. REFERENCES 1 2
Arends J, et al. ESPEN Guidelines on Enteral Nutrition: Non surgical oncology. Clin Nutr. 2006;25:245–259. Camidge D. The causes of dysphagia in carcinoma of the lung. J Roy Soc Med. 2001;94:567–572.
PWE-226 ENTERAL FEEDING IN NON-SURGICAL ONCOLOGY- IT'S NOT JUST HEAD AND NECK AND UPPER GI CANCERS R White*, S Freemantle, R Bracegirdle, S Chowdhury, M Roy, O Kegey, M Siemicka. Nutrition and Dietetics, Guys and St Thomas's NHS Foundation Trust, London, UK 10.1136/gutjnl-2015-309861.672
Introduction A significant amount of head and neck (H&N) and upper gastrointestinal (UGI) cancer patients require enteral nutrition (EN) at home. At our centre in 2014 alone we established 156 H&N patients and 52 UGI patients on home EN. However, a significant proportion of cancer patients with other tumours may also require EN. ESPEN guidelines recommend EN should be considered if under-nutrition exists, oral intake is < 60% of requirements and prognosis exceeds 2–3 months.1 Our aim was to determine the extent of EN use in non-surgical oncology patients (excluding H&N and UGI patients) and to compare its use against ESPEN guidelines. Method We undertook a retrospective review of dietetic records between January 2013 and December 2014 for all patients who required home EN. Data was analysed descriptively. Results 17 patients were initiated on EN during the data collection period. 16 patients were fed via naso-gastric tube (NGT) and 1 via percutaneous endoscopic gastrostomy (PEG), with 2 of the NGT’s later converted to gastrostomies. Table 1 shows the number of patients with EN by tumour site and stage of cancer
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PWE-227 A NUTRITION NURSE-DELIVERED NASOJEJUNAL TUBE INSERTION SERVICE PROMOTES APPROPRIATE USE OF NASOJEJUNAL NUTRITION SUPPORT AND IS ASSOCIATED WITH LOW RATES OF TUBE COMPLICATIONS S Hoey*, R Vincent, B Hayee, P Dubois. Gastroenterology, King's College Hospital, London, UK 10.1136/gutjnl-2015-309861.673
Introduction Nasojejunal tube (NJT) feeding provides a less costly and possibly safer alternative to parenteral nutrition (PN) in many settings including acute pancreatitis. However it is frequently underused due to reliance of NJT placement on radiological or endoscopic guidance, attendant delays and frequent mechanical complications including tube displacements and blockages. The Cortrak® electromagnetic imaging system allows bedside placement of NJT, is minimally invasive and avoids the need for radiological or endoscopic guidance. We introduced a Nutrition Clinical Nurse Specialist (CNS)delivered Cortrak® service at our hospital, as part of a Nutrition Support Service in which which all patients referred for PN or NJT feeding were reviewed by a member of the Nutrition Support Team and suitable patients identified proactively. Bedside A311
Abstracts NJT placement by the Nutrition CNS was followed by immediate verbal and written communication of tube aftercare instructions to ward staff after placement. An electronic referral system for Cortrak® NJT placement was implemented. Method Prospective data were collected on indications, placement success, procedure time and complications over a 10 month period between April 2014 and February 2015. Patients with surgically altered upper gastrointestinal tract anatomy were excluded. Successful placement was determined by inspection of Cortrak® NJT insertion traces, supplemented by abdominal xray in a minority of cases (n = 4) where jejunal tip position on Cortrak tracing was considered equivocal. Results 66 referrals for bedside NJ tube placement in adult patients were received, of which 16 (24%) were deemed unsuitable on clinical grounds. The most common reason for rejecting referrals was suitability for provision of adequate nutrition via oral or nasogastric routes (7/16, 44%). Of 35 patients suitable for NJT feeding, 20 (57%) had previously been receiving PN or had been referred for PN. 50 insertions were attempted on 35 patients, with successful NJT placement in 42 out of 50 (84%). The median procedure time was 15 min (range 3 to 60). There were no procedure related complications. Involuntary extubation occurred for 5 tubes (12%), and tube blockage in 1 (2.4%). Conclusion A Nutrition CNS-delivered bedside NJT insertion service has several benefits. Our data demonstrate high rates of conversion of nutrition support from PN to enteral and avoidance of inappropriate NJT insertion in 24% of cases. Cortrak ® NJT placement was successful in 84% of cases, similar to other series. The incidence of NJT blockage was low (2.4%) and may reflect better communication of tube aftercare instructions to ward staff made possible by a CNS placing tubes on the ward. Disclosure of interest None Declared.
PWE-228 PATIENT AND CARER EXPERIENCES OF LIVING WITH A JEJUNOSTOMY FEEDING TUBE AFTER SURGERY FOR OESOPHAGO-GASTRIC CANCER 1
V Halliday*, 2M Baker, 3A Thomas, 2D Bowrey. 1Dietetics, University of Sheffield, Sheffield; 2Surgery, University Hospitals of Leicester NHS Trust; 3Cancer Studies, University of Leicester, Leicester, UK
10.1136/gutjnl-2015-309861.674
Introduction Home jejunostomy tube feeding (JTF) can be used to support patients following oesophago-gastric surgery in order to ameliorate nutritional deficits. Previous studies have explored the effects of gastrostomy tube feeding, but little is known about the personal impact of having a JFT. The aim of this qualitative study was to explore how patients and their carers experience living with a JFT post surgery for esophago-gastric cancer. Method Participants were purposively sampled from a cohort of patients recruited to a trial investigating home enteral nutrition versus standard care after oesophagectomy or total gastrectomy for cancer. The sampling framework considered age, gender and marital status. Partners and carers of those included were also invited to participate. Interviews were audio recorded, transcribed verbatim and anonymised. Inductive thematic data analysis involved the research team reading and re-reading the transcripts followed by initial coding and cross-checking. Subthemes and themes were developed and then summarised. Data organisation and retrieval were managed using NVivo 10. Results Fifteen interviews (12 men) were conducted, lasting between 21 and 75 min. Eight interviews also included a partner
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or carer, all of whom were female. The mean age of the patients was 65.5 years (range 52 to 74 years) and most (67%) were married or co-habiting. All patients had a JFT placed at the time of surgery which had been used in the immediate postoperative period. Eleven had received artificial feeding post-discharge from hospital (duration of feeding 28 to 104 days). Interviews were conducted 2–3 months post surgery. Two main themes were identified, (1) Challenges and (2) Motivators of living with a JFT. Within these themes "Physical side effects", "Worries" and "Impact on routine" were the main challenges, while "Support", "Adaptation" and "Perceived benefit" were what motivated continuation of the intervention. All participants identified physical and psychosocial side effects related to having a tube, but the manner in which was expressed varied. Despite this, participants described how consistently well they coped, demonstrating high levels of compliance with stoma care and the feeding regimen. Conclusion A better understanding of the challenges of living with a JFT, and what motivates coping and compliance from the patient and carer perspective, may help health care teams provide proactive support to avoid preventable problems. Furthermore, this improved knowledge of what motivates patients to comply with a life-changing clinical intervention such as artificial feeding may provide valuable insight that can be used across other areas of health care. Disclosure of interest V. Halliday: None Declared, M. Baker: None Declared, A. Thomas Grant/ Research Support from: Fresenius-Kabi, D. Bowrey Grant/ Research Support from: Nutricia, Fresenius-Kabi.
Intestinal Failure PWE-229 INNOVATIONS IN ENTEROCUTANEOUS FISTULA MANAGEMENT: A SYSTEMATIC REVIEW JK Dastur*, S Nachiappan, Y Maeda, J Warusavitarne, C Vaizey. Colorectal Surgery, St. Mark's Hospital, London, UK 10.1136/gutjnl-2015-309861.675
Introduction Enterocutaneous fistulas are defined as abnormal communications between the gastrointestinal tract and the skin which may occur in various disease processes or iatrogenically. Patients who suffer with this condition manifest signs and symptoms of fluid and electrolyte imbalance, malnutrition and pain. Despite improvements in management and treatment modalities, mortality and morbidity rates remain high. This review aims to report on treatment innovations in this specialised field since 1980. Method A systematic review of studies reporting on techniques and modalities in ECF treatment was undertaken. Studies reporting on treatment of ECFs in inflammatory bowel disease settings, and negative pressure wound management modalities were excluded in this review. Results Thirty-six studies met the inclusion criteria. 32 were case series with small numbers, one was a case controlled study and three were systematic reviews/meta analysis. The newer modalities that have been described fell into the following categories: endoscopic (eight case series), surgical (six case series), percutaneous techniques (six case series and one case controlled study), other therapies (two case series) and pharmacological (10 case series and three systematic reviews/meta-analysis).
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