PD459 - DIFFICULTIES IN THE REAL-WORLD IMPLEMENTATION OF A ≤4HRS POST GASTROSTOMY PROTOCOL

PD459

DIFFICULTIES IN THE REAL-WORLD IMPLEMENTATION OF A ≤4HRS POST GASTROSTOMY PROTOCOL

G. Morvil^1,*, K. K. J. Teh¹, K. W. Lim¹, R. Ravi¹, R. Asokkumar ¹, W. L. Liou¹, Y. Y. Tan¹, E. Salazar¹, J. N. C. Chong¹, M. C. C. Cheah¹

¹Gastroenterology, Singapore General Hospital, Singapore, Singapore

Rationale: Post-gastrostomy feeding is frequently delayed despite baseline malnutrition. While ESPEN guidelines support initiation within 3–4 hours, real-world adoption is inconsistent. We evaluated the feasibility of an early feeding protocol (≤4 hours) in a tertiary care setting.

Methods: A retrospective review of patients undergoing gastrostomy insertion (2022–2026) was conducted. Following the introduction of an early feeding protocol, patients were categorized by time to first feed: ≤4hrs, 4-12hrs and >12hrs

Results: Of 221 patients, 7.7% were fed ≤4hrs. Indications were neurodegenerative diseases/stroke/traumatic brain injury (n=10), head/neck cancer (HNC) (n=5), and motor neuron disease (MND) (n=2). The majority, 78.3% were fed 4-12hrs (HNC 36.8%, MND 24.8%), while 14.0% were fed >12hrs (HNC 5.8%, MND 2.7%).

No instances of aspiration pneumonia, feed intolerance, refeeding syndrome, were noted in the cohort. 30-day mortality was 3.6%. In the <4hrs only one case of hypergranulation was recorded. In the 4-12hrs group, one case of gastrostomy dislodgement and one gastrostomy related bleeding was noted. No complications were noted in >12hrs

Implementation of the ≤4-hour protocol was hindered by workflow barriers; requirement for specialist nurse, dietitian, and physician reviews by 1700hrs. This was frequently exacerbated by late-afternoon procedures and delays in ward transfers.

Conclusion: Feeding within 4 hours of gastrostomy insertion proved safe and was not associated with increased complications. While workflow limitations resulted in only a 7.7% success rate for the ≤4-hour target, this represents a notable shift from previous practices where patients remained fasted until the following day. Successfully feeding the majority of patients (78.3%) within 12 hours marks a clinical improvement, though the ≤4-hour goal remains aspirational. These system barriers are being addressed through quality improvement interventions.

Disclosure of Interest: G. Morvil: None declared, K. Teh: None declared, K. W. Lim: None declared, R. Ravi: None declared, R. Asokkumar : None declared, W. L. Liou: None declared, Y. Y. Tan: None declared, E. Salazar: None declared, J. Chong: None declared, M. Cheah Speakers Bureau of: Speaker for AVANOS