Changes in gastroesophageal reflux in patients with nasogastric tube followed by percutaneous endoscopic gastrostomy

Abstract

Background/purpose: Despite frequent use of percutaneous endoscopic gastrostomy (PEG) for enteral feeding, the relationship between it and gastroesophageal reflux (GER) remains an incompletely answered question. We conducted this study to compare the GER between the same patients fed with a nasogastric (NG) tube and later with a PEG tube.

Methods: We enrolled 15 patients who had received NG tube feeding for > 6 months and were about to receive PEG tube insertion. We used Ponsky's pull method with 24 Fr feeding tubes. They received two GER scans, one just before PEG tube insertion and another 1 week after insertion. We drew regions of interest of radioactivity in the esophagus and stomach manually. The ratios of radioactivity of the region of interest in the esophagus over the stomach (GER ratio) were calculated to evaluate the severity of GER and compared.

Results: The GER ratios of these patients were all small and <3% except one that was 4.7% in one patient before PEG tube insertion. There was a small but substantial decrease (65% risk reduction) in GER ratio after PEG tube insertion. After arcsine transformation, the difference in the transformed data between patients fed with an NG tube and after PEG tube insertion was significant (t= 2.46, p = 0.028), and was lower after PEG tube insertion.

Conclusion: Our study demonstrates by scintigraphy a small but significant reduction of GER after shifting from NG to PEG tube feeding.