Long-term enteral feeding: a retrospective comparison of delivery via percutaneous endoscopic gastrostomy and nasoenteric tubes.

The use of percutaneous endoscopic gastrostomy (PEG) tubes for enteral feeding is widespread, although their superiority to other feeding devices, such as nasoenteric tubes (NET), has not been substantiated. We retrospectively compared clinical outcomes in patients who received enteral feeding via PEG (n = 80) or NET (n = 29) from 1984 to 1988. Mean follow-up was 192 days in the PEG group and 141 days in the NET group. Changes in nutritional and performance status were similar in both groups. Aspiration pneumonia occurred within 14 days of tube placement in 6% and 24% (p = 0.01) of the PEG and NET patients, respectively. With the exception of tube replacement, cumulative rates of minor and major complications (including aspiration pneumonia) were similar in both groups during follow-up. None of the clinical variables that were assessed correlated with the development of aspiration pneumonia. Mortality was similar in both groups. These results suggest that, for long-term enteral feeding, PEG offers no substantial advantages over NET with respect to patient nutrition, performance, or survival. The reasons for the observed difference in short-term aspiration pneumonia rates are unknown, and must be investigated prospectively.

Massive gastrointestinal hemorrhage in an immunosuppressed man due to gastric Kaposi's sarcoma.

Kaposi's sarcoma, a neoplasm that occurs in immunocompromised patients and people of Mediterranean origin, usually presents with skin lesions. However, extracutaneous lesions are common, and the gastrointestinal tract is often involved. We report the case of an iatrogenically immunosuppressed patient who presented with a massive upper gastrointestinal hemorrhage that was caused by Kaposi's sarcoma of the stomach. Kaposi's sarcoma in the setting of immunosuppression and the gastrointestinal manifestations of this disease are reviewed.