A randomized prospective trial of immediate vs. next-day feeding after percutaneous endoscopic gastrostomy in intensive care patients

Objective: To determine the effect of immediate vs. next-day feeding after percutaneous endoscopic gastrostomy in intensive care and intermediate care patients. Design and setting: A prospective, randomized, controlled trial of the clinical outcome in two German hospitals. Patients: The study included 80 patients: 40 in group 1 who received enteral feeding within 1 h and 40 in group 2 in whom feeding was started 24 h after percutaneous endoscopic gastrostomy feeding. Interventions: Patients were fed a polymeric iso-osmolar formula via pump 30 ml/h in 20 h on day 1, 70 on day 2, and 100 on day 3. Every 6 h for 72 h gastric residue was checked, and the patient was examined by a physician the first 3 days. Measurements and results: Comparing the maximum residual volumes for each group for each day as the major end-points, the immediate feeding group showed an increase of about 20-50% on each day, which, however, was significant only on day 2. Our study also failed to show any significant difference in complication rate or either short-term (1-3 days) or long-term (1-30 days) mortality. Conclusions: In acutely ill intensive and intermediate care patients immediate enteral feeding via a percutaneous endoscopic gastrostomy tube is as safe as next-day feeding.