A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke

Norton, Bernard; Homer-Ward, M; Donnelly, Mark; Long, Richard; Holmes, G. K. T.

doi:10.1136/bmj.312.7022.13

Cited by 388 publications

(168 citation statements)

References 14 publications

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“…Very recently, a randomized prospective study of thirty in-patients with persistent dysphagia 14 d following acute stroke, compared percutaneous gastrostomy and nasogastric tube feeding. Patients fed via the gastrostomy tube had significantly lower mortality and a greater improvement in nutritional status at 6 weeks (Norton et al 1996). In a double-blind placebo-controlled trial, ninety-six independently-living, healthy men and women over 65 years of age were randomly assigned to receive nutrient supplementation.…”

Section: Improving Nutritional Status In Hospital and Its Relation Tomentioning

confidence: 99%

Nutrition, ageing and ill health

1998

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There are physical, mental, social and environmental changes which take place with ageing; for example, decreased physical activity, increase in body fat, decrease in lean body mass and consequently decreased energy intake may be associated with physiological functions that affect metabolism, nutrient intake, physical activity and risk of disease. There are now many studies which have found that undernutrition is prevalent and often unrecognized in patients admitted to hospitals and institutions. There is also evidence which links protein-energy undernutrition or its markers with clinical outcomes in acute and non-acute hospital settings and that nutritional supplements can improve outcomes in some of these settings. However, most clinically-available nutrition screening instruments lack sensitivity and specificity, and abnormal nutritional indicators may simply reflect effects of age, functional disability, or severe underlying disease. Thus, causal relationship cannot be assumed without a sufficiently powerful intervention study which adequately adjusts for the effects of non-nutritional factors, such as the number and severity of co-morbid conditions on clinical outcome.

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Section: Improving Nutritional Status In Hospital and Its Relation Tomentioning

confidence: 99%

Nutrition, ageing and ill health

1998

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“…1 Previous studies have demonstrated mortality and nutritional benefits of gastrostomy feeding in certain subgroups of patients. 2,3 However, the demands for this procedure have increased, including conditions where the evidence base is often lacking. 4,5 This is highlighted by the rise in individuals receiving home enteral nutrition via their gastrostomy tubes.…”

Section: Introductionmentioning

confidence: 99%

Managing patients with gastrostomy tubes in the community: Can a dedicated enteral feed dietetic service reduce hospital readmissions?

et al. 2012

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BACKGROUND/OBJECTIVES: Post-gastrostomy complications range from 8 to 30%. These complications often occur following discharge into the community and may result in hospital readmission. Our unit previously reported a readmission rate of 23% in 6 months. There is a paucity of data evaluating community gastrostomy management. We therefore aimed to evaluate the benefits of a dedicated dietetic home enteral feed (HEF) team. SUBJECTS/METHODS: Demographic data, gastrostomy complications, readmission rates and HEF team input was prospectively collected from a cohort of discharged gastrostomy patients over a 1-year period and comparisons made with a similar historical cohort. RESULTS: A total of 371 complications were encountered in 313 gastrostomy patients during this period, with the commonest complication being over-granulated stoma sites (27%). Of these, 227 hospital admissions were avoided because of direct actions taken by the HEF team. Fifty-nine gastrostomy patients were admitted to the hospital, of which only seven (12%) were specifically for gastrostomy-related problems. Introduction of the HEF team significantly reduced gastrostomy-related hospital readmissions from 23 to 2% (P ¼ 0.0001). CONCLUSION: Although patients with gastrostomies may need attention to a variety of complex medical problems, many encounter problems specifically related to their gastrostomy after discharge. This is the largest prospective study demonstrating how dietitians trained in gastrostomy aftercare may optimize the management of gastrostomy complications and reduce unnecessary hospital readmissions.

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“…1 The benefit of gastrostomy insertion, with regard to morbidity and mortality, has been demonstrated in patients with cerebrovascular disease and oropharyngeal malignancy. [2][3][4] However, the demands for PEG insertion have risen to include conditions where the indications and long-term outcome are uncertain. 5,6 Dementia is an ever more common reason for PEG insertion when the patient cannot or will not eat.…”

mentioning

confidence: 99%

Percutaneous endoscopic gastrostomy: an effective strategy for gastrostomy feeding in patients with dementia

Sanders

Anderson

Bardhan³

2004

Clinical Medicine

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-Percutaneous endoscopic gastrostomy (PEG) is an accepted technique for longterm enteral feeding. Its use has increased because of its simplicity and low complication rate. The demands for gastrostomy insertion have risen and now encompass indications where the long-term outcomes are uncertain. Dementia has become one of the commonest indications for gastrostomy feeding. This article reviews the justification for PEG feeding in dementia and suggests a practical approach for this difficult clinical situation. The clinical strategy described in this paper can be applied to other neurodegenerative diseases and provides a framework for improving a PEG service.

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A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke

Abstract: This study indicates that early gastrostomy tube feeding is greatly superior to nasogastric tube feeding and should be the nutritional treatment of choice for patients with acute dysphagic stroke.

Cited by 388 publications

References 14 publications

Nutrition, ageing and ill health

Nutrition, ageing and ill health

Managing patients with gastrostomy tubes in the community: Can a dedicated enteral feed dietetic service reduce hospital readmissions?

Percutaneous endoscopic gastrostomy: an effective strategy for gastrostomy feeding in patients with dementia

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