The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Mark H Delegge - One of the best experts on this subject based on the ideXlab platform.
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Enteral Access and Enteral Nutrition in Patients With Short Bowel Syndrome
Adult Short Bowel Syndrome, 2019Co-Authors: Mark H DeleggeAbstract:Abstract Short bowel syndrome (SBS) is a complex disease that often requires complex solutions for providing nutritional support. Although parEnteral nutrition (PN) is the most common form of nutritional support for patients with SBS, oral nutrition or Enteral nutrition (EN) may be used alone or in combination with PN. In order to provide EN a patient may first receive Enteral access. Temporary feeding tubes, such as nasogastric and nasojejunal tubes, are uncommon for use in this population other than on a temporary basis. Percutaneous Enteral access can be placed by the radiologist, endoscopist, or surgeon and is often dependent on a healthcare center’s available expertise. Both gastric and jejunal Enteral access options are commercially available. A decision on what Enteral access tube to use is driven by the patients gut anatomy, tolerance to Enteral feeding, and comorbid disease states. Research on the use of Enteral feeding in the patient with SBS is limited; the use of continuous Enteral feeding has been shown to be associated with increased absorption of macronutrients. Data evaluating biomarkers for determination of which patient with SBS can be successfully fed with EN are inconsistent in their findings.
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Enteral feeding.
Current opinion in gastroenterology, 2008Co-Authors: Mark H DeleggeAbstract:Enteral nutrition is a widely used therapy for nutritional treatment of patients with multiple pathologies. The present review selects important evidenced-based papers from 2006 and 2007 and critically reviews them for the reader. Use of synbiotics and probiotics is gaining acceptance. Supplements such as glutamine may be important for wound healing. Enteral feeding in malnourished patients may result in rapid growth of gut mucosal protein. Antibiotics are important for reduction of postpercutaneous endoscopic gastrostomy infections. Early Enteral nutrition in burn patients blunts the hypermetabolic response. Polymeric Enteral formulations in vitro have a direct anti-inflammatory effect on enterocytes. Enteral nutrition, however, does not appear better than steroid use for induction of remission in Crohn's disease. Long-term (12-week) infusion of immune-enhancing Enteral formulas in a nonsurgical patient group is well tolerated and safe. Finally, large reviews of Enteral nutrition and their efficacy for specific disease states continue to demonstrate the difficulty in interpreting multiple small clinical studies. Enteral nutrition continues as a highly used medical therapy, usually as an adjuvant for other pharmacologic and supportive therapies. Multiple small clinical trials, observational studies and retrospective reviews must be analyzed to develop 'best practice' guidelines with Enteral nutrition.
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Risks of Endoscopic Enteral Access
Techniques in Gastrointestinal Endoscopy, 2008Co-Authors: Mark H Delegge, Amy J. BerryAbstract:Enteral nutrition therapy can improve outcomes in many disease states such as pancreatitis and inflammatory bowel disease, and in critically ill patients. Obtaining Enteral access is fundamental in order to provide Enteral nutrition. The endoscopist plays an important role in placing Enteral access systems. The endoscopist should be familiar with the techniques to perform percutaneous endoscopic gastrojejunostomy (PEG/J), direct percutaneous jejunostomy (DPEJ) and bedside nasoenteric tube placement as well as the management of complications that can result from their placement.
Gavin C. Harewood - One of the best experts on this subject based on the ideXlab platform.
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Enteral self-expandable stents.
Gastrointestinal endoscopy, 2003Co-Authors: Todd H. Baron, Gavin C. HarewoodAbstract:Enteral stents are defined as stents deployed within the stomach, small bowel, and colon. Enteral stents are designed to treat malignant luminal obstruction of the GI tract. Although their use is primarily for palliation of malignant obstruction, they also can be used within the colon as a preoperative modality. This review provides an overview of the techniques and outcomes of Enteral stent placement for malignant disease. Indications and strength of recommendations for Enteral stent placement are based on evidence and the quality thereof. Future areas for investigation of Enteral stents are proposed.
Christopher C Thompson - One of the best experts on this subject based on the ideXlab platform.
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eus guided gastroenterostomy versus Enteral stent placement for palliation of malignant gastric outlet obstruction
Surgical Endoscopy and Other Interventional Techniques, 2019Co-Authors: Joyce Y Young, William Dong, Christopher C ThompsonAbstract:EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO); however, data comparing EUS-GE to Enteral stent placement are limited. We aimed to compare clinical outcomes between EUS-GE and Enteral stent placement in the palliation of malignant GOO. Retrospective analysis of a prospectively collected database on patients who underwent EUS-GE or Enteral stent placement for palliation of malignant GOO from 2014 to 2017 was conducted. Primary outcome was the rate of stent failure requiring repeat intervention. Secondary outcomes included technical and clinical success, time to repeat intervention, length of hospital stay, and adverse events. A total of 100 consecutive patients (mean age 65.9 ± 11.9 years, 44.0% female) were identified, of which 78 underwent Enteral stent placement, and 22 underwent EUS-GE. Rate of stent failure requiring repeat intervention was higher in the Enteral stent group than the EUS-GE group (32.0% vs. 8.3%, p = 0.021). Technical success was achieved in 100% in both groups. Higher initial clinical success was attained in the EUS-GE group than the Enteral stent group (95.8% vs. 76.3%, p = 0.042). Mean length of hospital stay following stent placement was similar between groups (p = 0.821). The Enteral stent group trended towards increased adverse events (40.2% vs. 20.8%, p = 0.098). Kaplan–Meier analysis showed decreased stent function in the Enteral stent group (p = 0.013). Compared to Enteral stent placement, EUS-GE has a higher rate of initial clinical success and lower rate of stent failure requiring repeat intervention. EUS-GE may be offered for selected patients with malignant GOO in centers with extensive experience.
Todd H. Baron - One of the best experts on this subject based on the ideXlab platform.
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Enteral self-expandable stents.
Gastrointestinal endoscopy, 2003Co-Authors: Todd H. Baron, Gavin C. HarewoodAbstract:Enteral stents are defined as stents deployed within the stomach, small bowel, and colon. Enteral stents are designed to treat malignant luminal obstruction of the GI tract. Although their use is primarily for palliation of malignant obstruction, they also can be used within the colon as a preoperative modality. This review provides an overview of the techniques and outcomes of Enteral stent placement for malignant disease. Indications and strength of recommendations for Enteral stent placement are based on evidence and the quality thereof. Future areas for investigation of Enteral stents are proposed.
Edward A. Liechty - One of the best experts on this subject based on the ideXlab platform.
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Effect of Enteral versus parEnteral feeding on leucine kinetics and fuel utilization in premature newborns.
Pediatric Research, 1994Co-Authors: Scott C. Denne, Cheryl A Karn, Ya Mei Liu, Catherine A Leitch, Edward A. LiechtyAbstract:To determine whether the route of nutrient delivery affects whole-body protein kinetics and fuel utilization, eight premature newborns were studied during both a 4-h period of Enteral intake and a 4-h period of parEnteral nutrition. The kinetics of the essential amino acid leucine were measured using a constant tracer infusion of 1-13C-leucine, and fuel utilization and energy expenditure were assessed by respiratory calorimetry. All leucine kinetic parameters were similar during Enteral or parEnteral nutrition (in mean +/- SD mumol/kg/h, flux = 233 +/- 51 Enteral versus 258 +/- 42 parEnteral, leucine from protein breakdown = 177 +/- 50 Enteral versus 200 +/- 41 parEnteral, leucine oxidation = 57 +/- 26 Enteral versus 63 +/- 20 parEnteral, and leucine used for protein synthesis = 176 +/- 63 Enteral versus 196 +/- 50 parEnteral). In addition, overall rates of energy expenditure (approximately 52 kcal/kg/d) and pattern of fuel utilization (approximately 70% carbohydrate, 13% fat, 17% protein) were unaltered by the route of feeding. Thus, as reflected by leucine kinetics, overall rates of protein turnover, synthesis, oxidation, and breakdown as well as energy expenditure and fuel utilization are similar when nutrition is provided to premature newborns by either the Enteral or parEnteral route. These results suggest that short-term provision of parEnteral nutrition may be able to substitute appropriately for Enteral intake, at least with regard to the utilization of one essential amino acid and the overall pattern of fuel utilization.
