Home enteral nutrition (HEN) is an essential component in the care of patients with an array of underlying etiologies resulting in the inability to meet caloric needs through volitional intake alone. Although some would include oral nutrition supplementation as HEN, for the purposes of this review, the term is limited to a patient’s requiring an enteral access device for the delivery of exogenous nutrients. Complications related to such devices remain a difficult problem in the hospital setting, and these issues are often amplified when encountered in the home setting. Focused multidisciplinary teams and close follow-up are essential in optimizing outcomes for patients receiving HEN, but all healthcare providers should have foundational knowledge regarding commonly encountered complications of HEN access and the initial management of these issues.
de LuisDAAllerRIzaolaOTerrobaMCCabezasGCuellarLA.Experience of 6 years with home enteral nutrition in an area of Spain. Eur J Clin Nutr. 2006;60(4):553-557.
2.
PhillipsMSPonskyJL.Overview of enteral and parenteral feeding access techniques: principles and practice. Surg Clin North Am. 2011;91:897-911.
3.
TamiyaHYasunagaHMatusiHFushimiKAkishitaMOgawaS.Comparison of short-term mortality and morbidity between parenteral and enteral nutrition for adults without cancer: a propensity-matched analysis using a national inpatient database. Am J Clin Nutr. 2015;102(5):1222-1228.
4.
HowardLAmentMFlemingCRShikeMSteigerE.Current use and clinical outcome of home parenteral and enteral nutrition therapies in the United States. Gastroenterology. 1995;109:355-365.
5.
SchneiderSMPougetIStacciniPRampalPHebuterneX.Quality of life in long-term home enteral nutrition patients. Clin Nutr. 2000;19(1):23-28.
6.
GavazziCColatruglioSValorianiFet al. Impact of home enteral nutrition in malnourished patients with upper gastrointestinal cancer: a multicentre randomised clinical trial. Eur J Cancer. 2016;64:107-112.
7.
PlanasMLechaMGarcía LunaPPet al;Grupo de Trabajo NADYA-SENPE. The year 2002 National Registry on Home-Based Enteral Nutrition [in Spanish]. Nutr Hosp. 2005;20(4):254-258.
8.
KurienMWhiteSSimpsonGGrantJSandersDSMcAlindonME.Managing patients with gastrostomy tubes in the community: can a dedicated enteral feed dietetic service reduce hospital readmissions?Eur J Clin Nutr. 2012;66(6):757-760.
9.
BaroneMViggianiMTAmorusoAet al. Influence of age and type of underlying disease on complications related to home enteral nutrition: a single Italian center experience. JPEN J Parenter Enteral Nutr. 2014;38(8):991-995.
10.
AlivizatosVGavalaVAlexopoulosPApostolopoulosABajrucevicS.Feeding tube-related complications and problems in patients receiving long-term home enteral nutrition. Indian J Palliat Care. 2012;18(1):31-33.
11.
CrosbyJDuerksenDR.A prospective study of tube- and feeding-related complications in patients receiving long-term home enteral nutrition. JPEN J Parenter Enteral Nutr. 2007;31(4):274-277.
12.
CrosbyJDuerksenD.A retrospective survey of tube-related complications in patients receiving long-term home enteral nutrition. Dig Dis Sci. 2005;50(9):1712-1717.
13.
SilverHJWellmanNSArnoldDJLivingstoneASByersPM.Older adults receiving home enteral nutrition: enteral regimen, provider involvement, and health care outcomes. JPEN J Parenter Enteral Nutr. 2004;28(2):92-98.
14.
Castillo RabanedaRMGómez CandelaCde Cos BlancoAIGonzález FernándezBIglesias RosadoC.Evaluation of the cost of home enteral nutrition in relation to different access routes [in Spanish]. Nutr Hosp. 1998;13(6):320-324.
15.
BlumensteinIShastriYMSteinJ.Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014;20(26):8505-8524.
16.
NorthingtonLLymanBGuenterPIrvingSYDuesingL.Current practices in home management of nasogastric tube placement in pediatric patients: a survey of parents and homecare providers. J Pediatr Nurs. 2017;33:46-53.
17.
QuilliotDZallotCMalgrasAet al. Self-insertion of a nasogastric tube for home enteral nutrition: a pilot study. JPEN J Parenter Enteral Nutr. 2014;38(7):895-900.
18.
Task Force of ASPEN, American Dietetic Association Dietitians in Nutrition Support Dietetic Practice Group, RussellMet alAmerican Society for Parenteral and Enteral Nutrition (ASPEN) and American Dietetic Association (ADA): standards of practice and standards of pro- fessional performance for registered dietitians (generalist, specialty, and advanced) in nutrition support. Nutr Clin Pract. 2007;22(5):558-586.
19.
BankheadRBoullataJBrantleySet al; ASPEN Board of Directors. Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr. 2009;33(2):122-167.
20.
GaudererMPonskyJIzantRJr.Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15:872-875.
21.
RussellTBrotmanMNorrisF.Percutaneous endoscopic gastrostomy: a new simplified and cost effective technique. Am J Surg. 1984;148:132-137.
22.
DiSarioJA.Endoscopic approaches to enteral nutritional support. Best Pract Res Clin Gastroenterol. 2006;20(3):605-630.
23.
McClaveSAChangWK.Complications of enteral access. Gastrointest Enosc. 2003;58:739-751.
24.
LarsonDEBurtonDDSchroederKWDiMagnoEP.Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology. 1987;93:48-52.
25.
WilsonWRHaririSM.Experience with percutaneous endoscopic gastrostomy on an otolaryngology service. Ear Nose Throat J. 1995;74:760-762.
26.
PenderSMCourtneyMGRajanEMcAdamBFieldingJF. Percutaneous endoscopic gastrostomy: results of an Irish single unit series. Ir J Med Sci. 1993;162:452-455.
27.
GibsonSEWenigBLWatkinsJL.Complications of percutaneous endoscopic gastrostomy in head and neck cancer patients. Ann Otol Rhinol Laryngol. 1992;101:46-50.
28.
KozarekRABallTJRyanJr JA.When push comes to shove: a comparison between two methods of percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1986;81:642-646.
29.
RighiPDReddyDKWeisbergerECet al. Radiologic percutaneous gastrostomy: results in 56 patients with head and neck cancer. Laryngoscope. 1998;108:1020-1024.
30.
BeaverMEMyersJNGriffenbergLWaughK.Percutaneous fluoroscopic gastrostomy tube placement in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 1998;124:1141-1144.
31.
ShinJHParkAW.Updates on percutaneous radiologic gastrostomy/gastrojejunostomy and jejunostomy. Gut Liver. 2010;4(suppl 1):S25-S31.
32.
PeterAOSebastianskiMSelvarajahVGramlichL.Comparison of complication rates, types, and average tube patency between jejunostomy tubes and percutaneous gastrostomy tubes in a regional home enteral nutrition support program. Nutr Clin Pract. 2015;3:393-397.
33.
WiesenASideridisKFernandesAet al. True incidence and clinical significance of pneumoperitoneum after PEG placement: a prospective study. Gastrointest Endosc. 2006;64(6):886-889.
34.
BlumCSelanderCRuddyJet al. The incidence and clinical significance of pneumoperitoneum after percutaneous endoscopic gastrostomy: a review of 722 cases. Am Surg. 2009;75(1):39.
35.
MillerKRMcClaveSAKiralyLNMartindaleRGBennsMV.A tutorial on enteral access in adult patients in the hospitalized setting. JPEN J Parenter Enteral Nutr. 2014;38(3):282-295.
36.
PofahlWRingoldF.Management of early dislodgment of percutaneous endoscopic gastrostomy tubes. Surg Laparosc Endosc Percutan Tech. 1999;9(4):253-256.
37.
DateRSDasNBatesonPG.Unusual complications of ballooned feeding tubes. Ir Med J. 2002;95:181-182.
38.
MarcuardSPPerkinsAM.Clogging of feeding tubes. JPEN J Parenter Enteral Nutr. 1988;12(4):403-405.
39.
BittingerM.The buried bumper syndrome as a long-term complication of percutaneous endoscopic gastrostomy (PEG): management in a tertiary care canter. Gastrointest Endosc. 2005;61:AB161.
40.
NennstielSSchlagCMeiningA.Therapy of buried bumper syndrome via notes: a case report [in German]. Z Gastroenterol. 2013;51:744-746.
41.
BorehamBAmmoriBJ.Laparoscopic percutaneous endoscopic gastrostomy removal in a patient with buried-bumper syndrome:a new approach. Surg Laparosc Endosc Percutan Tech. 2002;12:356-358.
42.
EhsanSDyallLUbhiS.A novel laparoscopic approach for the surgical management of buried bumper syndrome. Ann R Coll Surg Engl. 2012;94:61-62.
43.
LeeTHLinJT.Clinical manifestations and management of buried bumper syndrome in patients with percutaneous endoscopic gastrostomy. Gastrointest Endosc. 2008;68:580-584.
44.
CyranyJRejchrtSKopacovaMBuresJ.Buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy. World J Gastroenterol. 2016;22(2):618-627.
45.
BallesterPAmmoriB.Laparoscopic removal and replacement of tube gastrostomy in the management of buried bumper syndrome. Internet Journal of Surgery. 2003;5:2.
46.
SheersRChapmanS.The buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy. Gut. 1998;43:586.
47.
LinHSIbrahimHZKhengJWFeeWETerrisDJ.Percutaneous endoscopic gastrostomy: strategies for prevention and management of complications. Laryngoscope. 2001;111:1847-1852.
48.
AbuksisGMorMSegalNet al. Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients. Am J Gastroenterol. 2000;95:128-132.
49.
TanakaHAraiKFujinoAet al. Treatment for hypergranulation at gastrostomy sites with sprinkling salt in paediatric patients. J Wound Care. 2013;22(1):17-18, 20.
50.
PhillipsMSPonskiJL.Overview of enteral and parenteral feeding access techniques: principles and practice. Surg Clin North Am. 2011:4:897-911.
51.
DannGCSquiresMHPostlewaitLMet al. An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: a seven-institution analysis of 837 patients from the U.S. gastric cancer collaborative. J Surg Oncol. 2015;112:195.
52.
ShikeMSchroyPRitchieMAet al. Percutaneous endoscopic jejunostomy in cancer patients with previous gastric resection. Gastrointest Endosc. 1987;33:372-374.
53.
MapleJTPetersenBTBaronTHet al. Direct percutaneous endoscopic jejunostomy: outcomes in 307 consecutive attempts. Am J Gastroenterol. 2005;100:2681-2688.
54.
StrongASharmaGDavisMet al. Direct percutaneous endoscopic jejunostomy (DPEJ) tube placement: a single institution experience and outcomes to 30 days and beyond. J Gastrointest Surg. 2017;21:446.
Tous RomeroMCAlarcóndel Agua I, ParejoCamposJet al. Comparison of two types of surgical gastrostomies, open and laparoscopic in home enteral nutrition [in Spanish]. Nutr Hosp. 2012;27(4):1304-1308.
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