Published in Progress in Rehabilitation Medicine, 2021
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Dysphagia is common in patients who have had a stroke, and often these patients will require a nasogastric tube feed (NGF) or enteral feeding via a percutaneous endoscopic gastrostomy (PEG). Both feeding routes have well documented advantages and disadvantages, and often it is the anticipated length of feeding time which dictates which route is used, with the PEG route often used for longer term feeding. Ikenaga et al (Japan) aimed to clarify the optimal feeding route for stroke patients in a rehabilitation ward, by investigating the rates of aspiration pneumonia, self-removal of the feeding tube and improvement in activities of daily living (ADL) of both NGT and PEG routes of nutrition support.
This study was a case-control design, using a central database (Kaga Regional Cooperation Clinical Pathway for Stroke) established in 2009. Data from 2010-2019 was analysed including 5278 patients enrolled in the database, of which 332 were identified as using enteral feeding on admission to the rehabilitation ward. Of these 96 cases were eligible for inclusion in this study; 47 cases in the PEG group (mean age 77.9 years, 45% female) and 49 cases in the NGT group (mean age 78.5 years, 47% female). The incidence of aspiration pneumonia was 4.67 times higher in the NGT group than the PEG group. There was no difference between groups on the improvement of ADL. In the patients with a PEG there will no self-removals of the feeding tube (0/47) compared with 19 self-removals in those receiving a NGT (19/30, p<0.01).
While this study is limited by the use of a retrospective database, it does highlight the benefits of PEG feeding for those that require long-term feeding. Consistent with other studies, the patients receiving a PEG feed had a lower incidence of aspiration pneumonia and self-removal of tube and had no difference on the improvement of ADL.