As a certified gastrostomy instructor, the author carried out a terminology survey concerning the viscosity and food intake/swallowing and educational activities in pharmacists, pharmacy students and pharmacy clerks. Interviews of students revealed extreme lack of knowledge about gastrostomy. In the practical training classes, the author organized experience learning about thickened water and morphological changes in enteral feeding products using thickening agents. The students who attended favorably evaluated the lectures and practical training. Educational activity of certified gastrostomy instructors is important not only for teaching pharmacists and pharmacy students correct gastrostomy preparation and management and nutritional therapy but also for their social ethics education.

A woman in her 70s who had undergone distal gastrectomy for gastric cancer suffered with oral intake, thus direct percutaneous endoscopic jejunostomy (DPEJ) was performed. However, as repeated vomiting of gastric juices and feeding materials occurred after initiating jejunal feeding, we changed the feeding site to 40 cm distal from the initial jejunostomy stoma by deploying a PEG-jejunal extension (PEG-J) tube. Since vomiting of gastric contents continued, an additional DPEJ was performed on an afferent loop and the tip of the catheter was placed in the residual stomach to drain the gastric contents. After this procedure, the patient rarely vomited and jejunal feeding was successfully re-started. It is suggested that decompression catheter placement from an afferent loop into the stomach is effective for cases which suffer impaired gastric drainage from the remnant stomach following partial gastrectomy.

Persistent gastrocutaneous fistulas have conventionally been treated surgically. Over-the-scope clip (OTSC) was developed as an endoscopic closure device for full-thickness gastrointestinal defects and has become one of the treatment options for gastrocutaneous fistula. Herein, we report two cases of gastrocutaneous fistulas treated using OTSC. Case 1 was a 71-year-old woman and case 2 was an 88-year-old man, both of whom had severe frailty and had a persistent gastrocutaneous fistula after removal of the percutaneous endoscopic gastrostomy (PEG) tube. OTSC closure was chosen over surgical closure to reduce invasiveness. In case 1, OTSC was deployed using a suction method, which was technically successful. However, the fistula reopened 2 days later, indicating clinical failure of the OTSC. The cause of the failure may be due to an inadequate suction of the fistula into the applicator cap. Based on the experience of OTSC failure in case 1, OTSC in case 2 was deployed using the Anchor to pull the fistula into the cap more reliably. Fistula did not recur during the 30-month follow-up, indicating the clinical success of OTSC in case 2. In summary, OTSC has the advantage of being less invasive compared to conventional surgery. Depending on the case, it may be necessary to devise a procedure such as using the Anchor. However, there is a dilemma that the use of Anchor increases cost.

Aim: We evaluated long-term prognostic factors of percutaneous endoscopic gastrostomy (PEG).

Methods: We studied 256 cases of PEG performed in our hospital. We examined the age, sex, disease, body mass index, blood examination results, and prognosis. We analyzed the relationship between these factors and the prognosis.

Results: The 1-, 3-, and 5-year survival rates were relatively 63.5%, 46.7%, and 39.1%. A univariate analysis revealed the age, sex, disease, serum albumin level, lymphocyte number, serum cholinesterase level, and C-reactive protein level to be associated with the prognosis. A multivariate analysis revealed cerebrovascular disease, neurological disease, and age to be independent prognostic factors (p<0.001, p<0.01, p=0.041).

Conclusion: Our study demonstrated that young patients with cerebrovascular disease or neurological disease have a relatively good prognosis.

Background: We compared the current status and prognosis between elderly patients aged≧90 years and aged from 85 to 89 years who underwent percutaneous endoscopic gastrostomy (PEG).

Methods: We divided 177 patients who underwent PEG between 2003 and 2020 into two groups: patients aged ≧90 years (Group A) and patients aged from 85 to 89 years (Group B) at the Seiwa Memorial Hospital. We retrospectively compared the following parameters between groups A and B: gender, primary diseases, nutritional methods and conditions, 30-day and total mortality rates, survival rates, and the cause of death.

Results: Statistically significant differences in age (p<0.0001), serum albumin levels (p=0.0104), and the average survival rate (p=0.0162) between the two groups were observed. Pneumonia was the most common cause of death in patients aged≧85 years.

Conclusion: Survival periods are short post-PEG placement for elderly patients aged≧90 years, and it is important to prevent pneumonia in these patients.

The aim of this study is to understand the current situation of changes to the new feeding enteral connectors. We conducted a written questionnaire survey to any medical institutions and nursing care facilities in Oita prefecture from August 1st to 31st, 2021, The response rate was 57%. Many of the responders were nurses, and although all of them in hospitals were aware of the change to new connectors, there were some facilities that did not know about it. In the free description, some problems regarding cooperation between facilities and procedures of the use of new connectors were highlighted. Patients using the feeding enteral tube might be expected to experience the disadvantages of changing to new connectors. There is an urgent need to develop an environment for sharing and resolving problems.