Percutaneous endoscopic gastrostomy: A randomized prospective comparison of early and delayed feeding

Background: It has been customary to initiate feeding through percutaneous endoscopic gastrostomy (PEG) tubes 24 hours or more after placement of these tubes. Recent changes in practice environment and emphasis on early discharge of hospitalized patients prompted us to evaluate early PEG feeding in a randomized prospective manner. Methods: Forty-one patients were included in the study. After an informed consent, the patients were randomly assigned to two groups, Group I (21 patients) received tube feedings 3 hours and Group II (20 patients) received feedings 24 hours after PEG placement. All patients received an iso-osmolar formula by continuous infusion at 30 ml/hour for the first 24 hours of feeding. The rates were then increased to 70 ml/hour, Residual volumes, tube length, peristomal leakage, and vital signs were checked, and a global assessment was done every 4 hours. Evaluation by a physician was done every 24 hours for 72 hours. If the residual volume was more than 60 mi (significant residual volume), the tube feedings were held for 2 hours. Patients exited the study at 72 hours from the time of procedure. All deaths were recorded to calculate 30-day mortality. Results: One patient (Group 2) died during the study period. Three patients (two in Group 1 and one in Group 2) had a significant residual volume, One patient (Group 1) had local skin infection requiring treatment. None of the patients had any signs of peritonitis or systemic infection. Conclusion: Early PEG tube feeding (3 hours after tube placement) is as safe as next day feeding in elderly patients.