Reddy KM, Lee P, Gor PJ, Cheesman A, Al-Hammadi N, Westrich DJ, Taylor J. Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes. World J Gastrointest Pharmacol Ther 2022; 13(5): 77-87 [PMID: 36157266 DOI: 10.4292/wjgpt.v13.i5.77]
Corresponding Author of This Article
Kavya M Reddy, MD, Attending Doctor, Instructor, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, 2780 Skypark Drive Suite 125, Torrance, CA 90505, United States. kavya036@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pharmacol Ther. Sep 5, 2022; 13(5): 77-87 Published online Sep 5, 2022. doi: 10.4292/wjgpt.v13.i5.77
Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes
Kavya M Reddy, Preston Lee, Parul J Gor, Antonio Cheesman, Noor Al-Hammadi, David John Westrich, Jason Taylor
Kavya M Reddy, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, United States
Preston Lee, Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States
Parul J Gor, Division of Gastroenterology and Hepatology, Mercy Hospital, Saint Louis, MO 63141, United States
Antonio Cheesman, David John Westrich, Jason Taylor, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO 63104, United States
Noor Al-Hammadi, Saint Louis University Center for Health Outcomes Research, Saint Louis University, Saint Louis, MO 63104, United States
Author contributions: Reddy KM and Taylor J contributed equally to this work and wrote the paper, collected data, and designed the research; Westrich DJ also contributed to data gathering, writing portions of the paper and critically revised the paper; Lee P and Gor PJ collected data and contributed to revisions of the manuscript; Cheesman A contributed to revisions of the manuscript; Al-Hammadi N performed all statistical analysis.
Institutional review board statement: The study was reviewed and approved by the Saint Louis University Institutional Review Board (Approval No. 29062).
Informed consent statement: Informed consent was waived by the Saint Louis University Institutional Review Board for this retrospective chart review.
Conflict-of-interest statement: None of the authors have any conflicts of interest.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kavya M Reddy, MD, Attending Doctor, Instructor, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, 2780 Skypark Drive Suite 125, Torrance, CA 90505, United States. kavya036@gmail.com
Received: October 23, 2021 Peer-review started: October 23, 2021 First decision: December 16, 2021 Revised: January 22, 2022 Accepted: August 14, 2022 Article in press: August 14, 2022 Published online: September 5, 2022 Processing time: 311 Days and 8.5 Hours
Abstract
BACKGROUND
Percutaneous Endoscopic Gastrostomy (PEG) tubes are often placed for dysphagia following a stroke in order to maintain sufficient caloric intake. The 2011 ASGE guidelines recommend delaying PEG tube placement for two weeks, as half of patients with dysphagia improve within 2 wk. There are few studies comparing outcomes based on timing of PEG tube placement, and there is increasing demand for early PEG tube placement to meet requirements for timely discharge to rehab and skilled nursing facilities.
AIM
To assess the safety of early (≤ 7 d post stroke) vs late (> 7 d post stroke) PEG tube placement and evaluate whether pre-procedural risk factors could predict mortality or complications.
METHODS
We performed a retrospective study of patients undergoing PEG tube placement for dysphagia following a stroke at two hospitals in Saint Louis, MO between January 2011 and December 2017. Patients were identified by keyword search of endoscopy reports. Mortality, peri-procedural complication rates, and post-procedural complication rates were compared in both groups. Predictors of morbidity and mortality such as protein-calorie malnutrition, presence of an independent cardiovascular risk equivalent, and presence of Systemic inflammatory response syndrome (SIRS) criteria or documented infection were evaluated by multivariate logistic regression.
RESULTS
154 patients had a PEG tube placed for dysphagia following a stroke, 92 in the late group and 62 in the early group. There were 32 observed deaths, with 8 occurring within 30 d of the procedure. There was an increase in peri-procedural and post-procedural complications with delayed PEG placement which was not statistically significant. Hospital length of stay was significantly less in patients with early PEG tube placement (12.9 vs 22.34 d, P < 0.001). Protein calorie malnutrition, presence of SIRS criteria and/or documented infection prior to procedure or having a cardiovascular disease risk equivalent did not significantly predict mortality or complications.
CONCLUSION
Early PEG tube placement following a stroke did not result in a higher rate of mortality or complications and significantly decreased hospital length of stay. Given similar safety outcomes in both groups, early PEG tube placement should be considered in the appropriate patient to potentially reduce length of hospital stay and incurred costs.
Core Tip: Percutaneous Endoscopic Gastrotomy (PEG) tubes are often placed for nutrition for dysphagia following a stroke. The 2011 ASGE guidelines recommend delaying PEG tube placement for two weeks, although this guideline is based on weak evidence. There is increasing demand for early PEG tube placement to meet requirements for timely discharge to rehab facilities. This is the first study to compare outcomes such as mortality or complications of PEG tubes based on timing of placement in stroke patients. Early PEG tube placement did not result in a higher rate of mortality or complications and significantly decreased hospital length of stay.
