Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background

Stroke patients commonly require enteral nutrition for dysphagia. Percutaneous endoscopic gastrostomy (PEG) tubes and nasogastric tubes are options for enteral feeding, but the optimal timing determining when PEG tubes should be placed is uncertain. The 2011 ASGE guidelines recommend waiting 2 wk for assessment of resolution of dysphagia prior to placing a PEG tube, but the recommendation is based on low quality evidence.

Research motivation

There is a demand for earlier placement of PEG tubes to facilitate earlier patient discharge to intensive rehab for neurologic recovery. An observational study using the Nationwide Patient Survey data found no difference in inpatient mortality or complication rates following early (within 7 d) PEG placement compared to delayed PEG placement after 7 d. This study was based on hospital data and could not provide longer term post-hospitalization outcomes or mortality. Further studies looking at the safety of early PEG placement are warranted.

Research objectives

This study aims to evaluate the safety of early (within 7 d) vs delayed (after 7 d) placement of PEG tubes in patients for dysphagia after acute stroke. Primary objectives were evaluation of 30- and 90-d mortality and rates of peri- and post-procedural complication. Secondary objectives included identification of predictors of morbidity and mortality in multivariate analysis.

Research methods

This bi-center, retrospective chart review identified 482 patients undergoing PEG placement based on endoscopy reports. After excluding patients with age < 18, PEG placed by surgery or interventional radiology, and indications other than dysphagia from acute stroke, 154 patients were identified for review, including 62 PEGs placed within 7 d of stroke and 92 placed after 7 d. Retrospective data was collected, and outcomes evaluated included rate of peri-procedural complications, rate of post-procedural complications, and 90-d all-cause mortality. Demographics and predictors of morbidity and mortality were also collected and evaluated in multivariate logistic regression.

Research results

Demographics and comorbidities were similar between groups, except for age (early 74.7 vs delayed 66.2 years, P = 0.0005). There was no statistically significant difference in peri- or post-procedural complication rate or mortality between groups. None of the proposed risk factors studies significantly impacted 30- or 90-d mortality, although protein-calorie malnutrition and presence of infection or SIRS criteria were non-significantly associated with an increase in complication rate. Finally, hospital length of stay was significantly lower in patients undergoing PEG tube placement (12.9 vs 22.3 d, P < 0.001).

Research conclusions

Early PEG placement was not associated with an increase in mortality or complications compared to delayed PEG placement in this retrospective chart review. This suggests early PEG placement is safe.

Research perspectives

Further prospective study to evaluate the safety of early PEG placement and reconsideration of the 2-wk delay in PEG placement is warranted.