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Background: Total parenteral nutrition (TPN) is an invasive and advanced rescue feeding technique that has acceptable short-term survival although at costs of substantial risks. Survival after the clinical use of TPN >6 mo is unknown., Objective: We determined long-term survival after clinical TPN use in a consecutive cohort who were attending an academic hospital., Design: The study included a prospective cohort with a retrospective analysis of all 537 consecutive episodes of TPN in 437 patients between January 2010 and April 2012. Follow-up was until October 2013 with a total follow-up of 608 patient-years. Survival was analyzed by using Kaplan-Meier and Cox regression., Results: Survival was 58% in 437 patients with a first-time use of TPN at an average of 1.5 y after the initiation of TPN. The mortality rate was 30 deaths/100 patient-years. Older age, admission at an intensive care unit or a nonsurgical department, lower body mass index, and an underlying malignancy were positively associated with mortality., Conclusion: TPN use, if correctly indicated, is a clinical sign of intestinal failure and a surrogate marker for markedly increased risk of mortality even >1.5 y after TPN use. This trial was registered at clinicaltrials.gov as NCT02189993 with protocol identification name TPN-01., (© 2014 American Society for Nutrition.)

Objective: Intestinal microbiota is important in health and disease. The aim of this study was to evaluate the effect of fructo-oligosaccharides (FOS) and fibre-enriched tube feeding on quality of life and intestinal microbiota (faecal Bifidobacteria)., Material and Methods: Nineteen out of 59 home-living, tube-feeding-dependent, adult patients and matched healthy controls were included in this randomized, double-blind study. After a washout period, patients received either no residue tube feeding (non-FOS group) or FOS and fibre-enriched tube feeding (FOS group). Quality of life as defined by the Gastrointestinal Quality of Life Index (GIQLI) and quantification of faecal Bifidobacteria were determined., Results: At baseline, GIQLI scores in controls and patients were 88+/-12 and 67+/-14, respectively (p=0.001). Following 6 weeks' intervention, GIQLI scores remained stable (65+/-14 versus 67+/-17) in the FOS group, whereas the non-FOS group values decreased (68+/-17 versus 64+/-19). Baseline faecal samples contained 2. 1x 10(7)+/-3.5 x 10(7) and 2.1 x 10(6)+/-5.6 x10(6)Bifidobacteria (p=0.002) in controls and patients, respectively, with no differences between patient groups. During the intervention, this number remained stable in the FOS group (0.7 x 10(6)+/-1.3 x 10(6) versus 1.0 x 10(6)+/-1.3 x 10(6) baseline versus end-point), but decreased in the non-FOS group (3.6 x1 0(6)+/-8.0 x 10(6) versus 2.5 x 10(4)+/-4.0 x 10(4)). GIQLI scores were correlated with the number of faecal Bifidobacteria (r=0.41, p=0.007)., Conclusions: The GIQL score for the tube-fed patients increased with the number of faecal Bifidobacteria, although in a non-linear way, and addition of FOS increased the number of Bifidobacteria. This suggests that prebiotic tube feeding may lead to a change in intestinal microbiota that could induce an increased quality of life in these patients.

Objectives: Percutaneous endoscopic gastrostomy (PEG) tubes have become an excellent alternative for the long-term management of patients with proximal obstructions of the gastrointestinal tract. However, their use has limitations and can be associated with serious complications. We therefore studied the frequency and severity of complications related to the use of PEG tubes in our clinic., Design: All adults (aged 18 years and above) in whom a PEG tube was placed between January 1 1994 and January 1 1999 at the Free University Hospital in Amsterdam were included in this study. In initial cases, the indication and procedure were individually judged according to a liberal protocol. However, after several major complications, a strict procedure protocol was implemented in September 1996., Results: During the study period, 263 PEG tubes were placed in 254 patients with head and neck cancer (n = 183; 70%), neurological disorders (n = 52; 20%) or severe upper gastrointestinal motility disorders (n = 28; 11%). In period I, 167 PEG tubes were placed and in period II, 96 PEG tubes were inserted. Patients were followed for a median 111 days. Minor complications occurred in 13% of the patients. Major complications occurred in 8% of the patients. In period I, the percentage of major complications was higher than in period II (9.5% versus 6%)., Conclusion: PEG tube placement is a safe procedure when performed according to strict guidelines. By doing so, PEG tubes allow optimal feeding for prolonged periods with the occasional need for replacement of the tube. PEG tubes should not be introduced in acutely ill patients, patients with a short life expectancy and preferably not to patients with severe coughing.