Enteral Nutrition by Endoscopic Means; II. Complications and Management

Zusammenfassung

In der Entstehung von Komplikationen einer enteralen oder Sondenernährung spielen gastrointestinale (z. B. Erbrechen, Diarrhö), mechanische (z. B. Sondendislokation oder -okklusion) oder metabolische (z. B. „Re-Feeding”-Syndrom, Hypoglykämie) Ursachen eine Rolle. Die Art und Häufigkeit dieser Komplikationen ist dabei abhängig von der Sondenplatzierung im Gastrointestinaltrakt (gastral vs. intestinal), der Zusammensetzung der Sondenkost und dem Schweregrad der Grunderkrankung. So wird beispielsweise das Auftreten sondenbedingter Komplikationen in der Literatur mit 0 - 20% angegeben, während 8 - 65% der Patienten postoperativ über gastrointestinale Symptome im Zuge einer Ernährungstherapie nach Anlage einer Feinnadelkatheterjejunostomie (offen chirurgisch oder laparaskopisch) klagen. Die Komplikationsrate lässt sich durch Beachtung der Richtlinien zur Sondenernährung, wie Zusammensetzung und Temperatur der Sondenkost, Zufuhrgeschwindigkeit und Portionsgröße sowie durch Anleitung des Patienten zur sachgemäßen Sondenpflege reduzieren. Mit Abstand am häufigsten werden gastrointestinale Nebenwirkungen beobachtet.

Abstract

Despite the benefits and the widespread use of enteral and tube feeding (ETF) some patients experience complications, which can be divided in three categories: mechanical, e. g., tube blockage or removal; gastrointestinal, e. g., vomiting, diarrhea; and metabolic, e. g., re-feeding syndrome, hyperglycemia. The type and frequency of complications related to tube feeding varies considerably in accordance with the access to the intestinal tract (e. g., nasoenteric vs. percutaneous gastric vs. small bowel), the composition of the formula diet used, and the severity of the underlying disease. For example, tube-related complications have been reported to occur in 0 - 20 % and gastrointestinal complications in 8 - 65 % of patients during early postoperative feeding via a needle catheter jejunostomy (NCJ) using comparable techniques. The complication rate can be reduced by careful observance of guidelines on tube feeding including those related to food composition, administration rate, portion size, food temperature, and supervision of the patient. Gastrointestinal side effects (including diarrhea) are without doubt the most frequent.

Schlüsselwörter

Perkutane endoskopische Gastrostomie - enterale Sondenernährung - Introducermethode - Pulltechnik - lokale Infektionen - Langzeiternährung - Button - Gastrostomie - jejunale Ernährung - nasoenterale Sonden - Refeeding-Syndrom

Key words

Percutaneous endoscopic gastrostomy - enteral tube feeding - introducer technique - pull method - local infections - long-term nutrition - skin-level gastrostomy - one-step button - jejunal nutrition - nasoenteral tube - re-feeding syndrome

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