OBJECTIVE: Motor neuron disease (MND) is a progressive neurodegenerative condition with a limited life expectancy. There is very little data on mortality and its associated factors beyond 30 days following gastrostomy. We explored the demographic, clinical, and nutritional predictors for early mortality at 30, 90, and 180 days following gastrostomy in these patients.
METHODS: This was a retrospective study involving 94 MND patients in Western Australia who underwent gastrostomy between 2015 and 2021. Patients were divided into two groups based on mortality at 30, 90, and 180 days post-gastrostomy. T-test (or Mann-Whitney), chi-square test and Fisher\'s exact test were used for detecting between-group differences in various factors. Multivariable logistic regression was used to identify factors associated with post-gastrostomy mortality at 90 and 180 days.
RESULTS: No mortality was attributable to gastrostomy-related complications. Lower forced vital capacity (FVC) (p = .039) and greater weight loss (%) (p = .022) from diagnosis to gastrostomy were observed in those who died within 30 days post-gastrostomy. Older age (p = .022), male sex (p = .041), lower FVC (p = .04), requiring but not tolerating noninvasive ventilation (p = .035), and greater weight loss (%) (p = .012) were independent predictors of 90-day post-gastrostomy mortality. However, only older age (p = .01) and greater weight loss (p = .009) were predictors of mortality at 180 days post-gastrostomy.
CONCLUSIONS: Our data indicated that mortality at 90 and 180 days was influenced by the weight loss (%) from diagnosis to gastrostomy, highlighting the importance of nutritional care in the MND population. Gastrostomy placement prior to substantial weight loss may reduce the risk of weight loss-associated mortality and warrants further investigation.

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It is important to identify true refractoriness of seizures, before escalation of anti-seizure medications, to avoid side effects of medications. Bioavailability of medications changes with the formulations used and changes significantly with the route of administration. Both of these were significantly impacted in a lady who was being fed via percutaneous endoscopic gastrostomy (PEG) feeds and deemed refractory to medications. After altering the formulations and the method, she became seizure-free.

BACKGROUND: Severe dysphagia poses a significant challenge for clinicians regarding feeding tube choices, practices, and timing due to a lack of evidence-based guidance.
OBJECTIVE: To assess national clinical practices and opinions on gastrostomy use in patients with atypical parkinsonian syndromes (APS) across the UK.
METHODS: Online survey was administered to clinicians and allied health professionals regarding availability of services, current use, perceived advantages, and problems associated with gastrostomy insertion.
RESULTS: We received responses from 47 respondents across 12 UK centers, including 44 clinicians specialized in APS. Consensus was observed regarding primary indications for gastrostomy insertion and circumstances justifying avoidance of the procedure. Limitations in recommending gastrostomy due to insufficient evidence on safety and outcomes, survival and quality of life were identified. Widespread agreement on delays in gastrostomy discussions was highlighted as a challenge in optimizing patient care, together with variability in current practices and concerns over the lack of a standardized gastrostomy pathway, emphasizing the need for further research to address existing evidence gaps.
CONCLUSIONS: This multi-center survey highlights agreement among clinicians on key aspects of indication, challenges, and limitations such as delayed decision-making and the absence of standardized pathways regarding the timing, method, and overall approach to gastrostomy insertion in APS. This study identified next steps to facilitate a more structured approach to future research toward a consensus on best practices for gastrostomy in APS. Addressing these challenges is crucial for enhancing patient outcomes and overall care quality in APS.

Gastrostomy feeding is a route of enteral nutrition for children with feeding difficulties. This study investigated caregiver experiences of the transition to gastrostomy feeding. A survey was administered to caregivers of children <18 years in a major pediatric center in Ireland. Experiences of decision-making, support, and adjusting to tube feeding were examined. Seventy-six caregivers participated. Median satisfaction with the information provided by the hospital was high. Almost half (48%) spoke to another caregiver of a child with a gastrostomy prior to their own child\'s gastrostomy insertion and most (88%) felt reassured by this. Concerns following insertion included managing the tube and their child\'s oral intake and feelings about the tube. The oral intake of 83% of children who had some intake prior to gastrostomy insertion did not change or increased following insertion. Most (89%) would make the same decision to insert the tube. Feelings associated with the transition included relief and stress. Gastrostomy tube insertion presents logistical and psychosocial challenges for caregivers. Peer support from other caregivers may alleviate some of these challenges.

OBJECTIVE: Hypoalbuminemia following One-Anastomosis Gastric Bypass (OAGB) surgery remains a major concern among bariatric surgeons. This study aims to assess the outcome of partial reversal to normal anatomy with gastro-gastrostomy alone in patients with refractory hypoalbuminemia following OAGB surgery.
METHODS: A retrospective study was performed on patients who underwent partial reversal surgery with gastro-gastrostomy alone due to refractory hypoalbuminemia post-OAGB surgery, using data from the Iran National Obesity Surgery Database, from 2013 to 2022.
RESULTS: Of 4640 individuals undergoing OAGB, 11 underwent gastro-gastrostomy due to refractory hypoalbuminemia. The median time from OAGB to partial reversal was 16.6 months and the BPL length ranged from 155 to 200 cm. The follow-up period ranged from 1 to 7 years. The mean BMI was 27.3 (7.5) kg/m² before partial reversal. The mean BMI post-reversal was 30.9 (4.2) kg/m² after 1 year and 33.3 (3.8) kg/m² after 2 years. Serum albumin levels significantly increased from 3.0 (0.4) g/dL to 4.0 (0.5) g/dL following gastro-gastrostomy (p-value < 0.001). Serum liver enzymes (SGOT, SGPT, ALP) significantly decreased post-gastro-gastrostomy (p-value < 0.05). Nine individuals (81.8%) achieved resolution of hypoalbuminemia after gastro-gastrostomy with maintenance of ≥ 20% TWL and ≥ 50% EWL. No cases of anastomotic stricture, leak, bleeding, or major complications were reported after gastro-gastrostomy.
CONCLUSIONS: Gastro-gastrostomy appears to be a safe and efficacious technique for addressing refractory hypoalbuminemia following OAGB. The procedure preserves the weight loss achieved following OAGB without significant complications. However, further studies are required to validate these findings.

Numerous patients stand to gain significant health benefits from enteral nutrition support facilitated by percutaneous feeding tubes. Consequently it is crucial for endoscopists, general practitioners, surgeons and neurologists to be well-versed with indications, contraindications and potential complications of PEG and other enteral feeding tubes. In this context we present a concise overview of the new national guidelines by the Swedish Society of Gastroenterology regarding the management of PEG and other enteral feeding tubes. Indications for the use of enteral feeding tubes include conditions such as stroke and obstructive cancer. The care of patients with percutaneous feeding tubes necessitates the expertise of a specialized team. Complications related to PEG include, among others, buried bumper syndrome, local infection and dislocation of the feeding tube.

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BACKGROUND: Ingestion of foreign bodies may be seen unconsciously or intentionally in patients with mental health problems. Most cases pass through the esophagus slowly; however, in some cases, the tumor may be located in narrower areas of the digestive tract that require endoscopic or surgical intervention. This study describes a rare case of successful removal of more than 450 pieces of metal objects from the stomach of a 36-year-old man via ingestion of foreign bodies at Imam Khomeini Hospital in Ahvaz.
METHODS: A 36-year-old male patient (Aryan race) presented with complaints of chronic abdominal pain, frequent vomiting, and intolerance to liquids and food. The patient\'s companions mentioned a history of gradual ingestion of small metal objects 3 months prior. The patient was conscious and had stable vital signs. In the patient\'s X-ray and endoscopy, multiple metal objects inside the patient\'s stomach were observed, causing gastric outlet obstruction. The patient underwent gastrostomy surgery, and 452 screws, nuts, keys, stones, and other metal parts weighing 2900 g were removed from the stomach. Five days after the operation, the patient was transferred to the psychiatric service in good general condition and was diagnosed with psychosis, and her condition returned to normal at follow-up.
CONCLUSIONS: Successful removal of this foreign body is rare. In chronic abdominal pain, especially in the context of psychiatric disorders, attention should be given to the ingestion of foreign bodies. In swallowing large amounts of sharp and metallic foreign objects, surgical intervention is necessary, especially in cases of obstruction, and saves the patient\'s life.

In this report, we present a case of a radiotherapy-induced tracheoesophageal fistula treated with the fluoroscopy-guided insertion of a covered stent through the gastrostomy route using both the antegrade and retrograde approaches. The initial antegrade endoscopic and fluoroscopic stent insertion procedure failed due to severe esophageal stricture. Compared to the endoscopic approaches, fluoroscopy-guided radiologic procedures are generally less invasive and more successful because they allow for a better understanding of the anatomy outside the lumen during the procedure and enable the use of devices with smaller diameters.
저자들은 방사선 치료 후 발생한 기관-식도루에 대해, 투시경을 이용하여 입(정방향) 과 위루(역방향)를 통하여 식도에 커버드 스텐트를 삽입한 증례를 보고한다. 투시경적 접근법은 내시경적 접근법과 비교하여 덜 침습적이고 성공률이 높을 수 있는데, 이는 투시경적 접근법이 시술 중 식도 바깥쪽의 구조를 파악할 수 있고, 더 얇은 구경의 기구들을 사용하기 때문이다.