Home Total Parenteral Nutrition for Intestinal Failure in Patients with Advanced Small Intestinal Neuroendocrine Neoplasms.

The role of total parenteral nutrition (TPN) in cancer patients is controversial, but it may be a treatment option for some patients with indolent but advanced small intestinal neuroendocrine neoplasms (SI-NENs). The aim of this study is to investigate whether home TPN was associated with long-term survival and to assess the indications, duration and complications of TPN in patients with advanced SI-NENs. Patients with advanced SI-NENs who received home TPN were retrospectively included. Electronic records were reviewed for clinical information. Five patients receiving home TPN were identified out of 1011 patients with SI-NENs in our center. The median duration of TPN administration was 12 mo. Small bowel obstruction was the most common reason for TPN initiation. TPN-related complications included two catheter infections, one thrombosis and one episode of TPN-related transaminitis. At the last follow-up, three patients had died and two were alive. The median survival was 12 mo. Overall estimated 1-yr probability of survival on home TPN by Kaplan-Meier analysis was 40%. In conclusion, home TPN may be a treatment option in highly selected advanced SI-NEN patients with severe gastrointestinal tract dysfunction. The initiation of home TPN is associated with long-term survival (≥1 yr), and complication rates appear acceptable.

Comminuted nasogastric tube fracture: a rare complication.

A nasogastric tube is commonly used as a method of enteral feeding or gastric decompression in clinical practice and its insertion is occasionally associated with local complications. In this case report, we present an extremely rare complication of a comminuted nasogastric tube fracture in a 54-year-old male patient receiving enteral feeding in hospital secondary to a diagnosis of haemophagocytic lymphohistiocytosis.

Buried bumper syndrome: do we have enough evidence?

Buried Bumper Syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG) tubes. Advice in prevention guidelines differ, but locally agreed protocols can be agreed using the existing evidence. Consideration needs to be given as to how tightly a PEG is clipped after insertion to prevent gastric leakage, and how long after the procedure should it be loosened to prevent BBS. The distance a PEG tube is advanced and whether it should be rotated is also important in order to prevent BBS. The locally developed protocols need to include clear instructions for staff and patients and a supportive education programme, alongside clear record keeping.

A loss of social eating: the experience of individuals living with gastroparesis.

AIMS AND OBJECTIVES: To report the experience of patients living with gastroparesis. BACKGROUND: The complex illness of gastroparesis is a condition of delayed gastric emptying associated with a range of different symptoms, including nausea, vomiting and depression, resulting in altered eating patterns. Patients are often over-investigated, treatments are not always successful, and quality of life is often impaired. DESIGN: A descriptive phenomenology study was undertaken to examine the experience of living with gastroparesis. Nine gastroparesis patients gave in-depth interviews. The interviews were transcribed, and framework analysis methods applied. METHODS: A descriptive phenomenology study was undertaken. Nine gastroparesis patients gave in-depth interviews. The interviews were transcribed, and framework analysis methods applied. RESULTS: Four main themes emerged: the first described their experiences and opinions of medical professionals, the second their understanding of mental health and mental illness, the third how they managed social settings and the fourth their identity and security. Their behaviour around food and mealtimes was often associated with feelings of loss, isolation and rejection, which influenced their reported quality of life. These factors resulted in their personal struggle to understand how this chronic, stigmatising illness affects their identity and their need for security. CONCLUSIONS: The complex illness of gastroparesis affects every aspect of patients' lives. As treatments for gastroparesis continue to evolve, therapies to help these patients address the psychological impact and the feelings of loss they report must not be overlooked. RELEVANCE TO CLINICAL PRACTICE: A better understanding of these patients' sense of loss of normal eating behaviour and the associated psychological distress needs to inform gastroparesis service provision with a view to developing a more holistic service for this patient group.