Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke.

Abstract

Objective: investigation of length of survival, complications, level of dependence and recovery of swallow in patients who received percutaneous endoscopic gastrostomy (PEG) feeding for dysphagia due to stroke.

Design: a retrospective case note analysis of patients treated between 1991 and 1995 and telephone survey of modified Barthel index in October 1996.

Setting: Cardiff Royal Infirmary and the University Hospital of Wales in Cardiff.

Subjects: 126 patients who had PEG inserted after dysphagic stroke.

Main outcome measures: complications of PEG, length of survival, duration of PEG feeding, recovery of swallow and modified Barthel index score.

Results: median length of follow-up was 31 months (range 4-71). Median duration of PEG use was 127 days (range 1-1372). For patients with PEG inserted within 2 weeks the median duration was 52 days (range 2-1478). At follow up 36 (29%) had had PEG removed, 72 (57%) had died with PEG in use, 10 (8%) still had PEG and were nil by mouth and five (4%) had PEG in use with swallow recovered. The median survival was 305 days. Thirty-five (28%) patients died in hospital. Aspiration pneumonia was the commonest complication. Thirty-three patients were alive in October 1996. The modified Barthel index for nursing home patients was 4 (range O- 13) and for patients at home 11 (range 2-20).

Conclusion: PEG feeding is safe and well tolerated in patients with dysphagic stroke. Early PEG placement (within 2 weeks) is worthwhile with many going on to have long-term feeding. Although overall mortality is high, some patients have a long-term survival and a few attain a reasonable level of function in daily living activities. Late recovery of swallow occurs and patients should have follow-up swallowing assessment.

Keywords: aspiration pneumonia, dysphagia, percutaneous endoscopic gastrostomy, stroke

Introduction

Since being described in 1980 [1], percutaneous endoscopic gastrostomy (PEG) has become the preferred method of long-term enteral feeding. PEG tubes are better tolerated than nasogastric tubes and provide better short-term nutrition [2, 3]. They may improve the rehabilitation potential of patients [4]. Dysphagia associated with stroke is the commonest indication for PEG feeding [5-7] and the number of PEG tubes inserted has increased greatly in recent years.

Although the short-term benefits are clear, the long-term outcome of PEG feeding after dysphagic stroke is poorly documented [8, 9]. Many of these patients remain severely disabled and there are considerable resource implications of long-term survival. We investigated the length of survival, complications, level of dependence and recovery of swallow in patients who received PEG feeding after dysphagic stroke.

Methods

A retrospective analysis was undertaken of patients who had a PEG inserted for acute stroke with dysphagia, between 1991 and 1995 at the University Hospital of Wales, Cardiff and the Cardiff …