A RANDOMIZED PROSPECTIVE COMPARISON OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY AND NASOGASTRIC TUBE-FEEDING AFTER ACUTE DYSPHAGIC STROKE

Objective-To compare percutaneous endoscopic gastrostomy and nasogastr ic tube feeding after acute dysphagic stroke. Design-Randomised prospe ctive study of inpatients with acute stroke requiring enteral nutritio n. Setting-One university hospital (Nottingham) and one district gener al hospital (Derby). Subjects-30 patients with persisting dysphagia at 14 days after acute stroke: 16 patients were randomised to gastrostom y tube feeding and 14 to nasogastric tube feeding. Main outcome measur es-Six week mortality; amount of feed administered; change in nutritio nal state; treatment failure; and length of hospital stay. Results-Mor tality at 6 weeks was significantly lower in the gastrostomy group wit h two deaths (12%) compared with eight deaths (57%) in the nasogastric group (P<0.05). All gastrostomy fed patients (16) received the total prescribed feed whereas 10/14 (71%) of nasogastric patients lost at le ast one day's feed. Nasogastric patients received a significantly (P<0 .001) smaller proportion of their prescribed feed (78%; 95% confidence interval 63% to 94%) compared with the gastrostomy group (100%). Pati ents fed via a gastrostomy tube showed greater improvement in nutritio nal state, according to several different criteria at six weeks compar ed with the nasogastric group. In the gastrostomy group the mean album in concentration increased from 27.1 g/l (24.5 g/l to 29.7 g/l to 30.1 g/l (28.3 g/l to 31.9 g/l. In contrast, among the nasogastric group t here was a reduction from 31.4 g/l (28.6 g/l to 34.2 g/l) to 22.3 g/l (20.7 g/l to 23.9 g/l) (P<0.003). In addition, there were fewer treatm ent failures in the gastrostomy group (0/16 versus 3/14). Six patients from the gastrostomy group were discharged from hospital within six w eeks of the procedure compared with none from the nasogastric group (P <0.05). Conclusion-This study indicates that early gastrostomy tube fe eding is greatly superior to nasogastric tube feeding and should be th e nutritional treatment of choice for patients with acute dysphagic st roke.