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Biomedical subjects

L Latkany

Publications and source records attributed to L Latkany.

4 recordsLinked to original sources
PubMed1998

Direct percutaneous endoscopic jejunostomy.

Jejunal feeding often is preferable to gastric feeding, particularly in the following situations: high risk for aspiration; gastric resection (partial or total); gastric pull-up; gastric outlet obstruction; obstructed or nonfunctioning gastrojejunostomy; and gastric dysmotility. The technique of placing a thin tube through a gastrostomy tube and pulling it endoscopically into the proximal jejunum allows delivery of nutrients into the jejunum. The results of this technique, however, have been poor. The direct percutaneous endoscopic jejunostomy technique allows placement of tubes directly in the jejunum with a success rate of around 85% and a minimal complication rate which is comparable to that of PEGs.

Endoscopy, Gastrointestinal↗
PubMed1997

A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy.

OBJECTIVE: The purpose of the study was to determine whether early postoperative enteral feeding with an immune-enhancing formula (IEF) decreases morbidity, mortality, and length of hospital stay in patients with upper gastrointestinal (GI) cancer. SUMMARY BACKGROUND DATA: Early enteral feeding with an IEF has been associated with improved outcome in trauma and critical care patients. Evaluable data documenting reduced complications after major upper GI surgery for malignancy with early enteral feeding are limited. METHODS: Between March 1994 and August 1996, 195 patients with a preoperative diagnosis of esophageal (n = 23), gastric (n = 75), peripancreatic (n = 86), or bile duct (n = 11) cancer underwent resection and were randomized to IEF via jejunostomy tube or control (CNTL). Tube feedings were supplemented with arginine, RNA, and omega-3 fatty acids, begun on postoperative 1, and advanced to a goal of 25 kcal/kg per day. The CNTL involved intravenous crystalloid solutions. Statistical analysis was by t test, chi square, or logistic regression. RESULTS: Patient demographics, nutritional status, and operative factors were similar between the groups. Caloric intake was 61% and 22% of goal for the IEF and CNTL groups, respectively. The IEF group received significantly more protein, carbohydrate, lipids and immune-enhancing nutrients than did the CNTL group. There were no significant differences in the number of minor, major, or infectious wound complications between the groups. There was one bowel necrosis associated with IEF requiring reoperation. Hospital mortality was 2.5% and median length of hospital stay was 11 days, which was not different between the groups. CONCLUSION: Early enteral feeding with an IEF was not beneficial and should not be used in a routine fashion after surgery for upper GI malignancies.

Aged↗
PubMed1996

Direct percutaneous endoscopic jejunostomies for enteral feeding.

BACKGROUND: Enteral feeding through percutaneous endoscopic gastrostomy (PEG) is increasingly utilized in hospitals, homes, and institutions. However, PEGs have two major limitations: (1) risk for aspiration, which occurs in up to 30% of patients, and (2) it does not allow enteral feeding in patients with gastric outlet obstruction, gastroparesis, or gastric resection. METHODS: A new endoscopic method for placement of direct percutaneous endoscopic jejunostomy (DPEJ) was attempted in 150 patients with or without a history of major abdominal surgery. Patients were followed-up until tube utilization ceased because of death or resumption of oral feeding. RESULTS: There were 129 (86%) successful procedures and 21 (14%) unsuccessful attempts. Procedure-related complications included nine (6%) incisional infections. Bleeding, abscess, and colonic perforation each occurred in one patient (.6%), and all required surgical intervention. On long-term follow-up (n = 97), tube malfunction occurred in 3 patients (3%) and aspiration in 3 (3%). Duration of tube use in this population was 113 +/- 173 days. CONCLUSIONS: DPEJs can be performed successfully with a low complication rate. Enteral feeding through DPEJs drastically reduces aspiration, which commonly occurs with PEG feeding. DPEJs allow feeding and hydration of patients with gastric outlet obstruction due to cancer who are not surgical candidates, eliminate the need for intravenous hydration and feeding, and can cut costs of hospitalization and treatment.

Endoscopy↗