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

Objective: investigation of length of survival, complications, level of dep endence and recovery of swallow in patients who received percutaneous endos copic gastrostomy (PEG) feeding for dysphagia due to stroke. esign: 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 Ca rdiff. Subjects: 126 patients who had PEG inserted after dysphagic stroke. Main outcome measures: complications of PEG, length of survival, duration o f PEG feeding, recovery of swallow and modified Barthel index score. Results: median length of follow-up was 31 months (range 4-71). Median dura tion 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 u p 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 swall ow recovered. The median survival was 305 days. Thirty-five (28%) patients died in hospital. Aspiration pneumonia was the commonest complication. Thir ty-three patients were alive in October 1996. The modified Barthel index fo r nursing home patients was 4 (range 0-13) and for patients at home 11 (ran ge 2-20). Conclusion: PEG feeding is safe and well tolerated in patients with dysphag ic stroke. Early PEG placement (within 2 weeks) is worthwhile with many goi ng on to have long-term feeding. Although overall mortality is high, some p atients have a long-term survival and a few attain a reasonable level of fu nction in daily Living activities. Late recovery of swallow occurs and pati ents should have follow-up swallowing assessment.