Endoscopic gastrostomy for nutritional support in post-stroke dysphagia

Abstract

Introduction: persistent dysphagia affects 15 % of stroke patients and contributes to malnutrition, aspiration, and death. This study aimed to characterize patients with post-stroke dysphagia who 1 underwent percutaneous endoscopic gastrostomy (PEG), and to assess the impact of PEG feeding on nutritional status and outcome.Methods: an observational and retrospective study using records from patients with post-stroke dysphagia who underwent PEG. Body mass index (BMI), serum albumin, transferrin, and cholesterol were recorded at the time of PEG insertion (T0) and 3 months later (T3).The evolution of these parameters was analyzed and compared to survival.Results: we obtained data from 158 patients (53.2 % males) with a median age of 75 years. Most strokes were ischemic (n = 135, 85.4 %). Median time between stroke and PEG was 2 months. Median survival after gastrostomy was 16 months. At admission, 41.6 % of patients had low BMI, 62.3 % low albumin, 68.6 % low transferrin, and 59.6 % low cholesterol levels. The prevalence of low albumin and low transferrin was higher in the patients who underwent PEG more than 2 months after stroke. A significant increase in albumin and transferrin, and a normalization of cholesterol levels was observed after 3 months of PEG feeding. Mortality was 12.9 %, 27.7 %, and 40 % at 1, 3, and 12 months, respectively. Survival was lower in patients with low albumin, transferrin or total cholesterol at admission.Conclusions: the prevalence of malnutrition is high among patients with post-stroke dysphagia. PEG feeding improves albumin, transferrin, and cholesterol levels. Early post-PEG mortality is high and must be considered on an individual basis.

Preprocedural control of nutritional status score and prediction of early death after percutaneous endoscopic gastrostomy

“…Previous studies have reported albumin, lymphocyte count, and total cholesterol as risk factors for death after PEG 8,9,26–29 . Albumin is the most abundant protein in human serum and has been used for decades as an indicator of malnutrition in clinically stable patients 30 .…”

“…Previous studies have reported albumin, lymphocyte count, and total cholesterol as risk factors for death after PEG. 8 , 9 , 26 , 27 , 28 , 29 Albumin is the most abundant protein in human serum and has been used for decades as an indicator of malnutrition in clinically stable patients. 30 Several studies have reported that albumin is a good predictor of surgical outcomes 31 , 32 ; however, the relative contributions of malnutrition and advanced disease to hypoalbuminemia was not clear in these studies.…”