Outcomes after feeding gastrostomy insertion to reduce aspiration

Study of the outcomes of feeding gastrostomy insertion to reduce aspiration among patients with learning disabilities

People with learning disabilities are at heightened risk of aspiration associated with infections of the lower respiratory tract and pneumonia and are implicated in premature mortality.

In some instances, people undergo feeding gastrostomy insertion to reduce aspiration and associated risks. Where they lack the capacity to consent to such procedures, decisions are often based on judgements by others in their best interests.

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A study retrospectively appraised outcomes associated with feeding gastrostomy insertion for adults with learning disabilities, in terms of the effect on respiratory tract infection rates and mortality.

Outcomes of 58 people with a history of respiratory tract infection in the year before feeding gastrostomy insertion – and who were believed to be at heightened risk of aspiration – were compared with 156 people who had not had respiratory tract infections over the corresponding period and were therefore presumed to have had feeding gastrostomy insertion for indications other than aspiration.

Most likely to benefit

Overall, the study found feeding gastrostomy placement did not reduce the subsequent incidence of lower respiratory tract infections – indeed a small increase in mortality was reported. Those with histories of probable aspiration remained at greatest risk.

The authors suggest more research is needed to establish subgroups most likely to benefit from feeding gastrostomy placement and that this should be considered during ‘best interests’ decision-making processes.

Those providing care and support should remain vigilant and not disregard the possibility of infections warranting early medical attention simply because there is a feeding gastrostomy placement.

Reference

Harvey P, Thomas, T, Chandan J et al (2019) Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database. BMJ Open 9:

Dave Atkinson is an independent nurse consultant