Efficiency analysis on percutaneous endoscopic gastrostomy for patients with persistent dysphagia after stroke

Abstract

Objective To observe the effects of percutaneous endoscopic gastrostomy (PEG)on mortality and complications in patients with persistent dysphagia after stroke using a points-scoring system for selecting PEG indication. Methods A total of 75 patients were divided into low score group without PEG, high score group without PEG and low score group with PEG (n=25 each). The follow-up period was 18 months, and the differences in complications, mortalities and survival periods among groups were compared. Results The number of times of aspiration pneumonia was (1.36±1.44) in low score group, (1.96±2.28) in high score group, (0.36±0.64) in low score group with PEG, with statistically significant differences among three groups (H=7.148, P=0.028). No difference in the morbidity of aspiration pneumonia was found between low score group and high score group (P=0.189). The number of times of aspiration pneumonia was decreased in low score groups after PEG versus in low score group without PEG (P=0.030) and in high score group (P<0.01). The number of times of gastrointestinal hemorrhage was (0.48±0.77)in low score group, (0.64±0.91) in high score group, (0.12±0.33) in low score group with PEG, with statistically significant differences among three groups (H=5.532, P=0.063). No statistically significant difference in gastrointestinal hemorrhage was found between low score groups and low score group after PEG (P=0.430), as well as between low score group and low score group with PEG (P=0.079). The morbidity of gastrointestinal hemorrhage was lower in low score group than in high score group (P=0.012). The survival rate at the observation end was 88.0% (22/25), 52.0% (13/25) and 92.0% (23/25) in low score group, high score group and low score group with PEG, respectively, with statistically significant difference among the three groups (χ2=7.906, P=0.001). Kaplan-Meier survival curve showed that the survival period were longer in the low score group with or without PEG than in high score group (P<0.01) , but no statistically significant difference was found between low score groups with or without PEG (P=0.626). Conclusions The reasonable evaluation using a points-scoring system before PEG might predict the prognosis of such patients: the higher score would indicate higher mortality. PEG operation for low score group with better condition could decrease the aspiration pneumonia and decrease gastrointestinal hemorrhage significantly, but could not prolong general survival time and decrease general mortality. Key words: Stroke; Deglutition disorders; Gastrostomy