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

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.