Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, #21 Section 2 Nan-Ya South Road, Banciao City, Taipei, Taiwan.
J Formos Med Assoc. 2011 Feb;110(2):115-9. doi: 10.1016/S0929-6646(11)60018-1.
BACKGROUND/PURPOSE: Despite frequent use of percutaneous endoscopic gastrostomy (PEG) for enteral feeding, the relationship between it and gastroesophageal reflux (GER) remains an incompletely answered question. We conducted this study to compare the GER between the same patients fed with a nasogastric (NG) tube and later with a PEG tube.
We enrolled 15 patients who had received NG tube feeding for > 6 months and were about to receive PEG tube insertion. We used Ponsky's pull method with 24 Fr feeding tubes. They received two GER scans, one just before PEG tube insertion and another 1 week after insertion. We drew regions of interest of radioactivity in the esophagus and stomach manually. The ratios of radioactivity of the region of interest in the esophagus over the stomach (GER ratio) were calculated to evaluate the severity of GER and compared.
The GER ratios of these patients were all small and <3% except one that was 4.7% in one patient before PEG tube insertion. There was a small but substantial decrease (65% risk reduction) in GER ratio after PEG tube insertion. After arcsine transformation, the difference in the transformed data between patients fed with an NG tube and after PEG tube insertion was significant (t= 2.46, p = 0.028), and was lower after PEG tube insertion.
Our study demonstrates by scintigraphy a small but significant reduction of GER after shifting from NG to PEG tube feeding.
背景/目的：尽管经皮内镜胃造口术（PEG）常用于肠内喂养，但它与胃食管反流（GER）之间的关系仍然是一个尚未完全解答的问题。我们进行这项研究，旨在比较同一批患者在使用鼻胃管（NG）喂养和随后使用 PEG 管喂养时的 GER。
我们纳入了 15 名接受 NG 管喂养>6 个月且即将接受 PEG 管插入的患者。我们使用 Ponsky 的牵拉法使用 24Fr 喂养管。他们接受了两次 GER 扫描，一次在 PEG 管插入前，另一次在插入后 1 周。我们手动绘制食管和胃的放射性感兴趣区域。计算食管和胃的放射性感兴趣区域的放射性比值（GER 比值），以评估 GER 的严重程度并进行比较。
这些患者的 GER 比值均较小且<3%，除了 1 名患者在 PEG 管插入前为 4.7%。PEG 管插入后，GER 比值有小但实质性的下降（65%的风险降低）。经过反正弦转换，NG 管喂养和 PEG 管插入后患者的转换数据之间存在显著差异（t=2.46，p=0.028），PEG 管插入后 GER 比值较低。
我们的研究通过闪烁扫描显示，从 NG 管喂养转换为 PEG 管喂养后，GER 有小但显著的减少。
