Clinical Nutrition (2003) 22(3): 261–266 r 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0261-5614(03)00005-0 ORIGINAL ARTICLE Homeenteralnutritioninadults:aEuropean multicentresurvey X.HEBUTERNE, n F.BOZZETTI, w J.M.MORENOVILLARES, z M.PERTKIEWICZ, y J.SHAFFER, x M.STAUN, nn P.THUL, ww A.VANGOSSUM, zz ESPENöHOME ARTIFICIALNUTRITIONWORKINGGROUP n DepartmentofGastroenterologyandNutrition,Ho Œ pitaldel 0 Archet,Nice,France, w DivisionediChirurgiadell’ApparatoDigerente IstitutoNazionaleperloStudioelaCuradeiTumoriViaVenezian1,20133Milano,Italy, z Hospital12deOctobre,U.NutricionClinicaY Dietetica,CarreteraAndaluciaKM5-428041Madrid,Spain, y DepartmentofGeneralandGastroenterologicalSurgeryandNutrition, MedicalUniversityofWarsaw,Poland, x IntestinalFailureUnitHopeHospital,Salford,UK, nn DepartmentofMedicalGastroenterology, Rigshospitalet,Blegdamsvej9,DK-2100Copenhagen,Denmark, ww DepartmentofSurgery,Charite Ł UniversityHospital,10098Berlin, Germany, zz ServicedeGastroenterologieHospital,ErasmeUniversiteLibredeBruxelles,1070Bruxelles,Belgium(Correspondenceto: XH,DepartmentofGastroenterologyandNutrition,Ho Œ spitaldel 0 Archet,06202Nicecedex3,France) Abstractö Aims: Thisstudywasundertakentoreportindicationsandpracticeofhomeenteralnutrition(HEN)inEurope. Methods: AquestionnaireonHENpracticewassentto23centresfromBelgium(B),Denmark(D),France(F),Germany (G),Italy(I),Poland(P),Spain(S)andtheUnitedKingdom(UK).ThisinvolvedadultpatientsnewlyregisteredinHEN programmefrom1January1998to31December1998. Results: Atotalof1397patients(532women,865men)were registered.ThemedianincidenceofHENwas163patients/millioninhabitants/year(range:62^457).Agedistributionwas 7.5%,16^40years;37.1%,41^65years;34.5%,66^80yearsand20.9% 480years.Thechiefunderlyingdiseaseswerea neurologicaldisorder(49.1%),orheadandneckcancer(26.5%);themainreasonforHENwasdysphagia(84.6%).A percutaneousendoscopicgastrostomy(58.2%)oranaso-gastrictube(29.3%)wereusedtoinfusecommercialstan- dardorhighenergydiets(65.3%),or¢brediets(24.5%);infusionwascyclical(61.5%)orbolus(34.1%).Indicationsand feedswerequitesimilarthroughoutthedi¡erentcentresbutsomedi¡erencesexistconcerningtheunderlyingdisease. There was greater variationin the choice of tubes and mode of infusion. In F, G, I, S, and UK, costs of HENare fully funded.InB,D,andPpatientshavetopaypartorallofthecharges. Conclusions: InEurope,HENwasutilisedmainlyin dysphagicpatientswithneurologicaldisordersorcancer,usingastandardfeedviaaPEG.However,therewereimpor- tantdi¡erencesamongthecountriesintheunderlyingdiseasestreated,theroutesused,themodeofadministrationand thefunding. r 2003ElsevierScienceLtd.Allrightsreserved. Key words: nutrition; malnutrition; elderly; cancer; ent- eral nutrition; home care; percutaneous endoscopic gastrostomy Introduction Enteral nutrition (EN) is the treatment of choice for patients who cannot maintain sufficient oral intake but have a functioning gastrointestinal tract (1). Although EN is generally required for several months, it does not justify keeping the patient in the hospital. In the United States, during the period 1989–1992, the yearly prevalence of home enteral nutrition (HEN) was estimated at 463 per million population (2) and a total of 357 million dollars was spent on HEN in 1992. In many European countries, HEN has been fully funded for the past 10 years, resulting in the rapid development of this technique (3). However, the current incidence, prevalence and practice of HEN throughout the different European countries is un- known. In 1999, a multicentre retrospective survey of HEN in Europe was performed by the ESPEN-Home Artificial Nutritional (HAN) working group, covering the period January to December 1998 to assess indications and practice of HEN in a number of different countries throughout Europe. Methods A questionnaire on HEN practice was designed by the members of the ESPEN-HAN working group. It focused on adult patients (age more than 16 years) newly registered in HEN programme between 1 January 1998 and 31 December 1998. It requested information about the underlying diseases, indications for HEN, technical aspects, training programme, and cost to the patient. The distribution of the questionnaire to the HEN centres was performed via eight members of 261