The safe use of percutaneous gastrostomy for enteral nutrition in patients with Crohn's disease.

OBJECTIVE: To determine the safety of percutaneous endoscopic gastrostomy (PEG) tube placement for nutritional support and/or defined therapeutic enteral nutrition (TEN) in adult patients with Crohn's disease.

DESIGN: A prospective, observational study of patients with Crohn's disease in whom PEG tubes were placed for nutritional support or TEN.

SETTING: A specialist nutrition clinic at a gastroenterology tertiary referral centre in Harrow, UK.

PARTICIPANTS: Nine patients with Crohn's disease. Seven patients had nutritional failure and were unable to tolerate nasogastric feeding, and two patients were recruited in whom TEN therapy for active disease was indicated. The age range was 21-52 years (median, 30 years). Five patients were female; all had had previous ileo-colonic resections, one had a gastro-enterostomy and one had a non-healing Crohn's-related gastric ulcer.

INTERVENTIONS: PEG insertion (Fresenius, Frecka 9 Fr) was performed at endoscopy with intravenous sedation. Follow-up with tubes in situ was for a median of 37 weeks (range, 4-276 weeks), and for a further median of 80 weeks (range, 52-120 weeks) in those whose tubes have been removed.

MAIN OUTCOME MEASURES: The level of disease activity, nutritional status/body mass index and any complications associated with PEG tube placement were recorded.

RESULTS: PEG was achieved in all patients; the only complication was a minor superficial entry site infection. Five patients continue to use PEG feeding to good effect, including healing of the Crohn's-associated ulcer. One patient now eats normally having regained target weight, and three require parenteral nutrition, having failed to achieve nutritional sufficiency despite an optimal enteral regimen via the PEG. An adverse body image in one of these patients (an opiate abuser with a long psychiatric history) was probably contributory to PEG failure. There was no peristomal or fistulous disease.

CONCLUSIONS: Although nutrition via PEG is not always successful, failures are of enteral nutrition, and not of the means. PEG use in selected patients with Crohn's disease appears safe and can prove a useful addition to therapeutic options.