Early Percutaneous Endoscopic Gastrostomy Research Articles

OROPHARYNGEAL PROLONGED DYSPHAGIA AFTER ACUTE STROKE: DIAGNOSIS AND CLINICAL PREDICTORS

Background: Dysphagia following acute stroke can be a serious threat to one's health because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. There is an evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. Objectives: To predict risk factors ofprolonged dysphagia following acute stroke and proper management of similar cases. Subjects and Methods: This study was a prospective cohort study conducted on 113 patients with acute stroke admitted within 24 hours. Clinical findings and imaging results were prospectively collected, and subsequent progress was recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (≥14 days); or prolonged dysphagia (>14 days). Particular attention was paid to bulbar function. Stroke severity was assessed using the National Institutes of Health Stroke Scale on admission and on discharge. The water swallow test was performed to all patients who were able to attend sufficiently to follow the instructions. Modified Barium Swallow or Video-fluoroscopy test was done for some patients to detect the oropharyngeal dysphagia. Results: Significant associations for prolonged dysphagia were seen with large stroke, increased stroke severity, dysphasia and lesions of the frontal and insular cortex and presence of old vascular insult on brain imaging. Conclusion: These results indicated that it is potentially possible to identify those patients who have prolonged significant dysphagia following acute stroke at an early time point. This would allow the judicious use of early PEG to avoid aspiration pneumonia and for better nutrition.

Early percutaneous endoscopic gastrostomy and nutritional supplementation for patients with head and neck cancer: an Italian survey of head and neck radiation oncologists.

The aim of this paper is to survey among Italian radiation oncologists about the role of nutritional supplementation and an early placement of endoscopic percutaneous gastrostomy in head and neck cancer patients treated with radiotherapy or chemo-radiotherapy. The survey was carried out in 106 Italian centers of radiation oncology through a SurveyMonkey online interface questionnaire. The response rate to the survey was of 63%, with 67 analyzable questionnaires. The majority of the respondents do not use preventive nutritional supplement. In 73.1% of the cases, percutaneous endoscopic gastrostomy (PEG) is positioned only in case of necessity. The 82.1% of the interviewed physicians, indeed, argued that the preventive placement of the endoscopic percutaneous gastrostomy should not be a standard procedure. Nutritional counseling before starting a treatment is not a routine, but 88.1% of the respondents stated that this should represent a standard procedure. Although some studies agree that a reactive approach should be preferred to an early endoscopic percutaneous gastrostomy placement, firm evidences and a clear consensus are still lacking. This survey shows a wide agreement about both timing and criteria for endoscopic percutaneous gastrostomy placement; however, the management of nutritional supplementation in head and neck cancer patients appears to be still widely variable and to deserve more focused studies.

PO-126: Early percutaneous endoscopic gastrostomy and nutritional supplementation in H&N cancer: an Italian survey

PO-126: Early percutaneous endoscopic gastrostomy and nutritional supplementation in H&N cancer: an Italian survey

Gastric outlet obstruction: An unusual adverse event of percutaneous endoscopic gastrostomy

Dear Editor, A 75-year-old woman living in a nursing home presented with a 24-hour history of abdominal cramping and vomiting. Medical history was remarkable for dementia and a percutaneous endoscopic gastrostomy (PEG) was performed 3 years earlier. The day before the admission the feeding tube was accidentally pulled out and a Foley catheter was placed in order to avoid stoma closure. On physical examination, there was extravasation of the gastric content through the stoma. The base of the "Y" of the Foley catheter was introduced in the gastric stoma and a pulling sensation was felt when it was mobilized. The remainder abdominal examination was unremarkable. On esophagogastroduodenoscopy the Foley catheter was identified passing the pylorus and pulling duodenal bulb towards the antrum (Figure 1). Advancing the scope through the duodenum, the Foley balloon impacted in the duodenal apex was identified. There was no mucosal injury so the balloon was deflated and the catheter removed. A 14 Fr. Bard PEG tube was latter placed to allow a reduction in the calibre of the stoma. Gastric outlet obstruction is an unusual adverse event of PEG tubes. In adults it is usually related to Foley catheters use as peristalsis can pull the balloon into the duodenum in the absence of an external bumper. A clinical picture of abdominal cramping, vomiting and resistance to the attempt of percutaneous reposition should raise the suspicion of gastrostomy tube migration through the pylorus. Foley catheters are easily available and some may use it to prevent gastrostomy closure after accidentally PEG tube extraction. We have performed more than 800 PEG and assisted several cases of gastric outlet obstruction and even stoma damage in this setting. This case emphasises the importance of receiving an early PEG tube with external bumper replacement to prevent this adverse event.

Long‐term outcome after percutaneous endoscopic gastrostomy in geriatric Mexican patients

To evaluate long-term survival and prognostic factors in elderly Mexican patients who have undergone percutaneous endoscopic gastrostomy (PEG). The present study was a retrospective cohort analysis of 110 patients aged older than 70 years without head and neck malignancy who underwent PEG between January 2005 and December 2012. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for demographic and clinical variables, and survival was determined by the Kaplan-Meier method. Medium age and follow up were 82.45 ± 6.6 years and 688.3 ± 394.6 days, respectively. The patients who died in the early postoperative period (n = 6) were older than those who survived. The Karnofsky performance status and lymphocyte count were non-significantly lower in non-survivors. The body mass index and serum albumin level were lower in non-survivors (P = 0.03 and 0.01, respectively) and Charlson's Comorbidity Index (CCI) was higher. A total of 32 (29%) patients died later in the postoperative period with a mean follow up of 436.2 ± 267.4 days. Risk factors for mortality included Karnofsky Performance Status (odds ratio [OR] 9.76, 95% CI: 3.26-29.3), CCI (OR 7.04, 95% CI: 2.31-21.41) and postoperative hypoalbuminemia (OR 3.45, 95% CI: 1.71-6.67). Postgastrostomy pneumonia occurred in 36.8% of the patients who died during follow-up (OR 0.28, 95% CI: 0.6-1.26). Karnofsky performance status, Charlson's comorbidity index and postoperative hypoalbuminemia, were independent risk factors for mortality. Modifiable factors are related to nutritional support. Early PEG may help prevent malnutrition and infection.

PP132: The role of early percutaneus endoscopic gastrostomy placement in patients with head and neck cancer treated by combined radiotherapy–chemotherapy

Purpose This study evaluates the outcome of early percutaneous endoscopic gastrostomy (PEG) placement in patients treated with concurrent chemoradiotherapy for advanced head neck cancer. Materials and methods From January 2010 until May 2012 a series of consecutive patients with advanced squamous cell head and neck cancer planned for radical treatment with long course or hypofractionated radiation therapy, underwent PEG placement. We retrospectively analyzed their records to determine the effect of early PEG placement on treatment completion without interruption. It is well known that combined chemoradiotherapy increases mucosal toxicity leading to decreased nutritional intake, weight loss and treatment interruption. Patients had a planning CT scan using individual immobilization with a thermoplastic device and were treated with 3D conformal radiotherapy to a total dose of 36 Gy in thirteen fractions ( hypofractionation schedule) or 66 Gy in 33 fractions (long course).They received concomitantly weekly platinum-based chemotherapy. Results Early percutaneous endoscopic gastrostomy (PEG) was correlated with fewer interruptions of treatment and a better nutritional status. Conclusions The results showed that patients with locally advanced head and neck carcinoma undergoing radiotherapy with curative intent and concomitant chemotherapy, had significant clinical benefit from the early placement of PEG. Prophylactic PEG maintains a sufficient nutritional status and reduces the incidence of treatment interruption due to therapy toxicity.

Early Insertion of Percutaneous Endoscopic Gastrostomy in Patients with Isolated Elevated White Blood Cell Counts

Purpose: Percutaneous Endoscopic Gastrostomy (PEG) is a common procedure for patients with dysphagia. Several large prospective trials for PEG have evaluated the efficacy of the procedure. Traditionally gastroenterologists have been hesitant to perform PEG insertions in patients with elevated white blood cell (wbc) counts. Literature review shows that very few published studies have analyzed the complications of PEG placement in otherwise non infected patients with isolated elevated WBC counts. The aim of our study was to analyze complications of PEG placement in patients with isolated elevated WBC counts as compared to patients with normalized wbc counts at the time of PEG placement. Methods: This was a retrospective cohort analysis of a total of 465 patients, 60 men and 405 women who underwent PEG placement. All patients who underwent PEG placement in IMC and NYMH from January 2005 to June 2010 were included in the study. The patients were followed up for a period of one year following PEG placement. Patients with fever, hematological malignancies or on steroids were excluded. A cut off value of 11,000/ml WBCs or above was considered elevated in the study. Patients in group 1 had elevated WBC counts at PEG insertion and patients in group 2 had normal WBC counts. All patients in this study were free from active infections at the time of surgery. This was supported by clinical, laboratory, microbiological and radiologic data obtained from chart review. All patients received preoperative antibiotics as short-term prophylaxis. The data was analyzed using IBM SPSS 20.0. The comparisons between the groups were made using student's t test, Chi-square test and ANOVA. Results: There was significant reduction of 5.19 days in the length of hospital stay with early insertion of PEG (p 0.03). There was no statistically significant increased risk of complications with early insertion of PEG in the presence of isolated elevated WBC counts. There were no cases of severe complications including necrotizing fasciitis, esophageal perforation, colocutaneous fistula, peritonitis, ileus, gastric outlet obstruction or death secondary to PEG placement in either group. Conclusion: In our study, there was no evidence of increased complications or mortality related to early PEG placement in patients with isolated elevated WBC counts. Therefore it is reasonable to consider early PEG placement in patients with isolated elevated wbc counts rather than delaying the PEG procedure for WBC counts to normalize. In our study, early insertion of PEG led to reduction in the average length of hospital stay by 5.19 days (p 0.03). This can lead to substantial reduction in health care costs. Further prospective studies are needed to confirm our findings.Table: Results of PEG placement in isolated elevated wbc counts vs normalized wbc counts

Prediction model for early percutaneous endoscopic gastrostomy (PEG) in head and neck cancer treatment

Head and neck cancer patients are prone to nutritional problems, partly due to the location and size of the disease, due to significant comorbidity and also often therapeutic intervention. Excessive weight loss after surgery reduces further the patients' physical resistibility and increases the complication rate for adjuvant radiation and or chemotherapy. Possible effective interventions are dietary counseling, nutritional supplements or drug interventions. Aim of our research was to reveal reliable clinical predictive parameters, which calculate risks as the reduced nutritional state against the possible complications of PEG insertion and finally define an algorithm for pre-therapeutic PEG insertion to optimize the general treatment conditions by sufficient nutrition. We explored the data of 152 patients in a time period from 2005 to 2010 considering age, gender, body mass index, staging, size and localization of the tumor or need for a neck dissection. The decisive predictive parameters are: body mass index, size and localization of tumor, lymph node affection, resection of the root of the tongue or the oropharynx region and performance of a neck dissection. In this retrospective study we established a prediction model that allows a substantiated evaluation of post-therapeutic dysphagia considering relevant clinical features as well as the specific surgical therapy. From this assessment derives the indication of a safe pre-therapeutic application of a percutaneous endoscopic gastrostomy (PEG).

The impact of early percutaneous endoscopic gastrostomy placement on treatment completeness and nutritional status in locally advanced head and neck cancer patients receiving chemoradiotherapy

To investigate the impact of early insertion of percutaneous endoscopic gastrostomy-tube on nutritional status and completeness of concurrent chemotherapy in locally advanced head and neck cancer patients treated with chemoradiotherapy. Twenty-three patients were enrolled into this prospective study. Gastrostomy-tube was inserted in patients before the initiation of chemoradiotherapy. There was not any significant change in nutritional parameters of patients that used their tube during treatment. Despite the grade 3 mucositis, the planned concurrent chemotherapy could be given in 70% of the patients. However, nine patients had weak compliance and their body weight (P = 0.01) and body mass index (P = 0.01) deteriorated in the first 4 weeks of chemoradiotherapy. The completeness of concurrent chemo-rate was 44% in these patients. Toxicity, requiring aggressive supportive care, may limit the chemotherapy part of curative concomitant chemoradiotherapy. By providing adequate enteral nutrition the insertion of gastrostomy-tube can increase the completeness rate of concurrent chemotherapy.

Impact of early percutaneous endoscopic gastrostomy tube placement on nutritional status and hospitalization in patients with head and neck cancer receiving definitive chemoradiation therapy

This study analyzed the impact of timing of percutaneous endoscopic gastrostomy (PEG) tube placement on clinical endpoints in patients undergoing concurrent chemoradiation therapy (CRT). In all, 111 patients who underwent CRT for locally advanced squamous cell carcinoma of the head and neck (SCCHN) were retrospectively analyzed to determine the effect of timing of PEG placement on weight loss, hospitalizations, and rates of PEG complications/dependence. Early PEG tube placement was correlated to reductions in weight loss during CRT (p < .001, R = 0.495), hospitalization for nutritional deficits (p = .011, R = 0.262), and magnitude of persistent weight loss at 6 weeks post-CRT (p = .003, R = 0.347). Disease control was the only predictor of PEG dependence. No differences were seen in PEG complication or dependence rates with earlier placement. The results of our series show that patients with locally advanced SCCHN undergoing definitive CRT may derive significant clinical benefit from the early placement of PEG tubes for nutritional supplementation.

Recent advances in motor neuron disease

Amyotrophic lateral sclerosis (ALS) is the most common and most aggressive form of adult onset motor neuron degeneration. Despite intensive research, riluzole remains the only drug with proven efficacy. The cause and pathogenesis of the motor neuron degeneration in ALS appears to be a complex and multifactorial process. In this study, we review recent advances in our understanding of the molecular basis of sporadic and familial forms of ALS and improvements in the treatment of ALS patients. The discovery of mutations in the DNA/RNA-binding proteins transactive response DNA-binding protein 43 (TDP-43) and fused in sarcoma in familial ALS and the cytosolic sequestration of TDP-43 occurring in sporadic ALS opens new avenues in ALS research and suggests that altered RNA processing may be involved in the disease pathogenesis. The survival of ALS patients continues to increase most likely due to noninvasive respiratory ventilation, early percutaneous endoscopic gastrostomy and multidisciplinary care in ALS clinics. Recent insights in the pathology and genetics of ALS have improved our understanding of motor neuron degeneration and will hopefully lead to novel treatment strategies in ALS. Awaiting these, the beneficial effect of multidisciplinary care of ALS patients on survival and quality of life has become clear.

Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy

Chemoradiotherapy for treatment of advanced head and neck cancer (HNC) is used to achieve organ preservation without compromising survival. Because chemoradiotherapy usually impacts adversely on nutritional and functional status, feeding by percutaneous endoscopic gastrostomy (PEG) is often part of the management regimen for these patients, but the presence of a PEG tube can also be associated with reduced quality of life (QOL). This study aimed to examine the factors associated with PEG insertion and the effects of PEG use on QOL and functional outcomes in HNC patients receiving chemoradiotherapy. Survey of 36 consecutive patients treated by primary chemoradiotherapy for HNC. Patient weight, age, tumour type, details of PEG insertion, feeding regimens and treatment were noted. The survey comprised the Performance Status Scale, the Functional Measure for Swallowing, Nutritional Mode and a self-assessment of QOL. PEG insertion within 1 month of treatment was associated with smaller fall in body mass index at 12 months than PEG insertion 1 month or more after the start of the treatment (P < 0.05). Body mass index change was inversely correlated with health-related quality of life and significantly related to lower speech and swallowing function scores. Longer PEG duration correlated with poorer performance status and swallowing function (P < 0.01). Longer PEG duration also predicted poorer overall QOL (P < 0.01) and poorer swallowing (P < 0.01) and speech (P < 0.05). Nutritional mode was related to overall QOL (P < 0.01). Nutritional support for HNC patients undergoing chemoradiotherapy is an essential component of patient care. Early PEG insertion and shorter PEG duration are associated with more favourable QOL-related outcomes.

Metastasis of carcinosarcoma of oesophagus to gastrostomy site

Patients with head and neck cancers need a percutaneous endoscopic gastrosotomy (PEG) before start of treatment to ensure adequate nutrition because worsening dysphagia during chemo radiation [Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J. Gastroenterol Hepatol 2000; 15: 21–5; Beer KT, Krause KB, Zuercher T, Stanga Z. Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer. Nutr Cancer 2005; 52: 29–34.]. However implantation of original tumor to the gastrostomy exit site is rare but serious complication of this procedure and here we report a case of PEG site metastasis along with relevant review of literature.

Is looped nasogastric tube feeding more effective than conventional nasogastric tube feeding for dysphagia in acute stroke?

BackgroundDysphagia occurs in up to 50% of patients admitted to hospital with acute strokes with up to 27% remaining by seven days. Up to 8% continue to have swallowing problems six months after their stroke with 1.7% still requiring enteral feeding. Nasogastric tubes (NGT) are the most commonly used method for providing enteral nutrition in early stroke, however they are easily and frequently removed leading to inadequate nutrition, early PEG (Percutaneous Endoscopic Gastrostomy) insertion or abandoning of feeding attempts. Looped nasogastric tube feeding may improve the delivery of nutrition to such patients.MethodsThree centre, two arm randomised controlled trial, with 50 participants in each arm comparing loop (the intervention) versus conventional nasogastric tube feeding. The primary outcome measure is proportion of intended feed delivered in the first 2 weeks. The study is designed to show a mean increase of feed delivery of 16% in the intervention group as compared with the control group, with 90% power at a 5% significance level. Secondary outcomes are treatment failures, mean volume of feed received, adverse events, cost-effectiveness, number of chest x-rays, number of nasogastric tubes and tolerability.Trial RegistrationISRCTN Number: ISRCTN61174381

High Rate of Percutaneous Endoscopic Gastrostomy Site Infections Due to Oropharyngeal Colonization

We prospectively analyzed peristomal infection agents during the first week following percutaneous endoscopic gastrostomy (PEG) placement by the pull technique in patients with head and neck cancer. Nasal and pharyngeal swabs were obtained from a consecutive series of cancer patients prior to PEG placement. All patients underwent antibiotic prophylaxis with cefotaxime and oral disinfection. PEG site infection was prospectively evaluated at days 2, 3, and 7 after insertion. Twenty-eight patients (25 males; mean age, 58 years) were included. Oropharyngeal or nasal colonization were observed in 68% (19/28) and 19% (5/28) of patients, respectively. Early infections occurred in 36% (10/28) of the patients, all with oropharyngeal colonization and concordance between agents (P=0.01). Three patients required hospital admission and 1 required surgery. Head and neck cancer patients with oropharyngeal colonization have a high risk of early PEG site infection with substantial morbidity owing to oral-stomal spread.

Incision vs. Non-Incision Technique of PEG Tube Placement, Success Rate and Early Complications

Purpose: Percutaneous endoscopic gastrostomy (PEG) tube placement with and without skin incision were compared with regard to success of technique, ease of placement, and early PEG site complications in a randomized, controlled, double blinded prospective study. Methods: 50 consecutive patients were randomized to PEG tube placement by pull technique with either 4 mm skin incision (n = 25) or no skin incision (n = 25). Patients were blinded to type of technique used. 92% of patients in each group received antibiotics. Peak pull-forces required to pull PEG through the abdominal wall, bleeding scores and time of procedure were recorded by an operator. All patients received standardized wound care. At days 2 and 7 post-PEG placement an investigator blinded to the type of technique assessed patients for PEG site skin infection, bleeding, and pain. Results: PEG placement was 100% successful in both groups of patients with no differences in procedure time. The mean procedure time for the incision group was 14.6 min; for the non-incision group it was 15.6 min (P > 0.05). Mean bleeding score during procedure was higher in the incision group 0.4 vs. non-incision group 0.12 (P < 0.05), while mean peak pull-forces were higher in the non-incision group 19.04 lb vs. incision group 11.69 lb (P < 0.05). One patient in the incision group required suturing and pressure to control continuing oozing of blood after the procedure. Mean infection scores were 0.16 for the incision group vs. 0 for the non-incision group (P > 0.05) on day 2, and 0.43 for the incision group vs. 1.37 for the non-incision group (P = 0.055) on day 7. Purulent MRSA PEG site abdominal wall infection in one patient from the non-incision group necessitated early PEG tube withdrawal and additional antibimicrobial therapy. Mean bleeding scores were 0.25 for the incision group vs. 0 for the non-incision group (P < 0.05) on day 2, and 0.13 for the incision group vs. 0.08 for the non-incision group (P > 0.05) on day 7. There was no statistically significant difference in pain scores on day 2 or 7. The mean pain score was <1 in both groups. Conclusions: PEG tube placement was feasible in all patients with both incision and non-incision techniques. When compared with the incision technique, the non-incision technique required significantly more forces to pull the PEG tube through the abdominal wall, was associated with lower periprocedural bleeding, and had higher mean infection scores on post-procedure day 7.

Early Percutaneous Endoscopic Gastrostomy Insertion Maintains Nutritional State in Patients With Aerodigestive Tract Cancer

Patients with upper aerodigestive tract (UAT) cancers often suffer from malnutrition and compromised functional ability. We compared clinical outcome with percutaneous endoscopic gastrostomy (PEG) tube feeding begun at two different time points. The records of 151 patients with UAT carcinomas were reviewed retrospectively. We included patients undergoing radical radiochemotherapy and PEG tube feeding. Subjects were evaluated before PEG insertion and at the end of the treatment. Patients (n = 15, 100%) were divided into two groups according to the presence (group A) or absence (group B) of mucositis. Group A (51.7% of patients) received early PEG: before or within 2 wk of radiotherapy. Group B (48.3%) received delayed PEG: between 2 wk and 3 mo after the start of radiotherapy. Mean weight loss was 1.03 kg in group A vs. 4.0 kg in group B, P = 0.004. Treatment interruptions were significantly (P = 0.01) more common in group B. Early PEG placement at the beginning of radiochemotherapy in patients with UAT tumors maintains the patient's nutritional state and reduces treatment interruptions.

Early percutaneous endoscopic gastrostomy nutrition in head and neck cancer patients

ObjectiveMany head and neck cancer patients suffer from poor nutrition. Nutrition is a problem during and after therapy, especially when it consists of extensive surgery, intensive (chemo)radiotherapy or their combination. Additional enteral nutrition has been provided by means of either nasogastric tube feeding, surgical gastrostomy, radiologic percutaneous gastrostomy or percutaneous endoscopic gastrostomy (PEG). Because of the straightforward, easy technique involved and its low complication rate, PEG has become established as the primary route of nutrition in these patients. Previously, the aim of assisted enteral nutrition was to compensate for already existing malnutrition; nowadays, an additional purpose is to diminish or prevent the development of malnutrition. The main objective of this study was to evaluate the safety of pre-treatment PEG in a sample of patients with an upper aerodigestive tract area malignancy treated in a tertiary referral centre.Material and methodsA total of 79 patients with an upper aerodigestive tract area malignancy were treated with a total of 80 PEGs during the period 1997–2001.ResultsMost of the PEGs (62/80; 77.5%) were performed by an otolaryngologist. An open gastrostomy was needed in five cases because of unsuccessful gastroscopy due to oesophageal stricture (n=4) or severe trismus (n=1). Both acute and late complications were minor and the respective complication rates (1/80; 1.3% and 12/80; 15%) were low. In addition, all complications were easily managed and did not seriously affect the actual treatment.ConclusionsA major advantage of having the PEG performed by the otorhinolaryngologist was the possibility to combine it easily with other necessary procedures, such as panendoscopy, tracheostomy and additional biopsy. In addition, the timing of the procedure was easy to schedule.

Endoscopic repair of gastrostomy after inadvertent removal of percutaneous endoscopic gastrostomy tube.

Percutaneous endoscopic gastrostomy (PEG) tube placement has become the preferred method of enteral feeding for many patients. Neurologic disease and cancer are the most frequent indications for PEG tube placement. PEG tubes are also becoming more frequent in trauma patients for early initiation of enteral feeding. Inadvertent PEG tube removal is a well-known complication of PEG tubes. Patients undergoing PEG tube placement are frequently malnourished and in poor general medical condition, making them relatively high risk for surgical intervention. In the past, after early inadvertent PEG removal, patients underwent laparotomy for surgical repair of the gastrostomy site. Recently, laparoscopic replacement of the PEG tube has been described. We present a new technique of endoscopic repair of the gastrostomy site with hemoclip placement followed by later PEG tube placement.

Percutaneous Endoscopic Gastrostomy (PEG) for Enteral Nutrition in Patients with Stroke

Background: The use of percutaneous endoscopic gastrostomy (PEG) for enteral nutrition in patients admitted for stroke is difficult, varying and needs specific consideration. There is therefore need for more data on this patient group. We examined the indications, survival, tube removal and time with PEG in stroke patients and in other patients with PEG with the aim of providing guidance for the management of enteral nutrition via PEG in stroke patients. Methods: Retrospective assessment of data from all stroke patients and patients with other diseases (control group) who had received PEG for enteral nutrition during a period of 8.5 years. Results: Eighty-three stroke patients with dysphagia received PEG after unsuccessful use of nasogastric tubes or long-term tube feeding. Early mortality rate was 19% in the stroke group, 26% in the older group (>74 years) and 12% in the younger group (60-74 years). The PEG tubes were later removed due to swallowing recovery in 20% of the older group and in 31% of the younger group. At 90 days, 50%-60% still needed PEG. The stroke patients were older compared to the control group ( n r = r 115); 30-day mortality was similar but more patients recovered the ability to swallow. Conclusions: Stroke patients are older than other patients who receive PEG; 27% have swallowing recovery and more than 75% have long-term need for PEG. Nasogastric tubes often fail, and the need for early PEG placement (within 2 weeks) must be assessed in appropriate patients. The patient's prognosis, the objective of nutritional treatment, duration of dysphagia, age and comorbidity should all be taken into consideration.