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Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke
A James1, K Kapur, A B Hawthorne
1Department of Gastroenterology, University Hospital of Wales, Heath Park, Cardiff, UK.
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 0-13) 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.