Feeding gastrostomy. Assistant or assassin?

Following several deaths from pulmonary aspiration in severely ill or chronically debilitated patients receiving nasogastric tube feedings, a study was undertaken to determine the incidence of aspiration pneumonitis in patients with feeding gastrostomies. During a 15-month interval, 22 feeding gastrostomies and nine feeding jejunostomies were performed. In the former group, eight patients experienced aspiration pneumonitis, with two deaths. Six patients with Stamm gastrostomies and two patients with permanent mucosal-lined gastrostomies experienced pulmonary aspiration. In contrast, aspiration pneumonia did not occur in our small series of patients with feeding jejunostomies. The high incidence of pulmonary aspiration in patients with feeding gastrostomies strongly suggests that, for chronic enteral nutrition in patients who are unable to protect their airway, a feeding jejunostomy is preferable to a feeding gastrostomy.