Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: A systematic review

Jaafar, Mohamad Hasif; Mahadeva, Sanjiv; Morgan, Kàren; Tan, Maw Pin

doi:10.1007/s12603-014-0527-z

Cited by 31 publications

(33 citation statements)

References 40 publications

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“…In addition, the sample size is considered small, but it is comparable or relatively larger than previous single-center studies. 6,8 Blinding was also not possible considering the nature of the interventions. While a larger, randomized, controlled study would be desirable to confirm our findings, the technical difficulties of conducting such a study may preclude this possibility.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 A recent systematic review, however, found limited evidence supporting the use of gastrostomy instead of NG in patients with non-stroke-related dysphagia, with meta-analyses of the few available studies, involving 146 patients, suggesting equivocal outcomes with regards to risk of complications. 8 Apart from South Korea and Japan, 9,10 several studies in Asia have reported that many older patients with dysphagia are commonly placed on long-term NG tube feeding, 11,12 often with poor nutrition outcomes. 4 In Taiwan, the majority of nursing home residents requiring tube feeding receive long-term enteral feeding via NG tube, rather than gastrostomy.…”

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confidence: 99%

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Long‐Term Nasogastric Versus Percutaneous Endoscopic Gastrostomy Tube Feeding in Older Asians With Dysphagia: A Pragmatic Study

et al. 2018

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Background A barrier to gastrostomy feeding exists among Asian clinicians and caregivers due to negative perceptions regarding complications. We compared clinical and nutrition outcomes in older dysphagic Asian patients with nasogastric (NG) or gastrostomy tube feeding using a pragmatic study design. Methods The choice of enteral tube access was determined by managing clinicians and patients/caregivers. Comparisons of tube feeding methods were made during a 4‐month period, adjusting statistically for inherent confounders. Results A total of 102 participants (NG: n = 52, gastrostomy: n = 50) were recruited over 2 years from 2013 to 2015. Subjects on long‐term NG tube feeding were older (82.67 ± 7.15 years vs 76.88 ± 7.37 years; P < .001) but both groups had similar clinical indications (stroke: 63.5% NG vs 54% gastrostomy; P = .33). After adjustment for confounders, gastrostomy feeding was associated with fewer tube‐related complications (adjusted odds ratio [aOR] = 0.19; 95% confidence interval [CI] = 0.06–0.60) and better complication‐free survival rate (aOR = 0.32; 95% CI = 0.12–0.89) at 4‐month follow‐up. Anthropometric and biochemical nutrition parameters improved significantly in both groups at 4 months, but no significant differences were observed at the end of the study. Conclusion Gastrostomy feeding is associated with a greater 4‐month complication‐free survival and lower tube‐related complications compared with long‐term NG feeding in older Asians with dysphagia. However, no differences in nutrition outcomes were observed between NG and gastrostomy feeding at 4 months.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Long‐Term Nasogastric Versus Percutaneous Endoscopic Gastrostomy Tube Feeding in Older Asians With Dysphagia: A Pragmatic Study

et al. 2018

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“…However, the acceptance of PEG tube feeding seems to vary considerably among different countries. There is a clear contrast between Asian and Western about the attitudes toward PEG feeding of clinicians as well as the clinical practice [12][13][14] . In North America, PEG tubes are most frequently recommended for long-term enteral nutrition by HCPs with nearly 40% of them holding the belief that PEG feeding is the standard of care for patients 15 .…”

Section: Introductionmentioning

confidence: 99%

Clinician's Attitude to Enteral Nutrition with Percutaneous Endoscopic Gastrostomy: A Survey in China

Zhang

et al. 2020

Preprint

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Background: Percutaneous endoscopic gastrostomy (PEG) are recommended for long-term enteral nutrition. However, long-term nasogastric (NGT) feeding is still commonplace in China. We surveyed Chinese clinicians’ opinions toward PEG feeding in order to identify the potential barriers to acceptancy of PEG feeding.Methods: A self-reported questionnaire was developed and distributed to 600 doctors. Five-point Likert scales were used for most responses.Results: Of 525 respondents, the mainly nutritional support method was NGT while PEG was less used. Doctors working in the tertiary class A hospitals and radiotherapy department were more likely to choose PEG feeding (p=0.000). Overall, 241 (46%) participants do not know PEG and 284 (54%) have different understanding degree of PEG. Age (p=0.002), working life (p=0.044) and professionalism (p=0.005) were significantly related to the understanding of PEG. Levels of agreement was high (score of 3.47) for using PEG in patients with prolonged stroke-associated dysphagia. There was high agreement level in the statement that PEG was unnecessary when NGT could sustain the basic needs of patients, though better outcome can be predicted with PEG feeding. The listed factors influencing physicians' choice of PEG for long-term feeding scored high for all items, ranging from 3.57 to 3.89. Conclusions: Doctors’ insufficient knowledge of PEG feeding, resistance from patients and families, poor cooperation among healthcare professionals (HCPs) and between departments, and a crisis of doctor-patient trust all influence the medical decision-making process, all these factors leading physicians to prefer more conservative treatment to avoid disputes rather than better ones.

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“…It has been reported that PEG technique can largely reduce the major complications, patient discomfort and cost 11. Importantly, some studies have revealed that feeding via a PEG tube is superior to NG tube from both a clinical and nutritional perspective 12,13. Research has shown that PEG can significantly increase survival rate, reduce aspiration rate and the slippage of catheter 14.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic efficacy of nutritional support by percutaneous endoscopic gastrostomy in critically ill patients: A self-control clinical trial

Fei¹,

Gao²,

Liu³

et al. 2017

Pak J Med Sci

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Background & Objective:Percutaneous endoscopic gastrostomy (PEG) is a procedure to provide enteral nutrition for critically ill patients. It is commonly used in clinical practice; however, the widespread use of PEG is controversial. Our objective was to evaluate the therapeutic effect of nutritional support by PEG in these critically ill patients.Methods:A total of 64 critically ill patients including 41 males and 23 females (aged 23-84) were identified by the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system during September 2004 to June 2012. The nutritional status before and after PEG was mainly assessed by the tricep skinfold thickness and serum albumin level. The nutritional status and pathological condition were assessed at 4, 8 and 12 weeks before and after PEG feeding. The assessment was according to the classical method of the human nutritional status. Follow-up was performed at one month, three months and 1.5 year after gastrostomy. Statistical analysis was performed by SPSS 11.5 software. The incidence of inhalation pneumonia and gastroesophageal regurgitation was compared by chi square (χ2) test. P<0.05 were considered statistically significant.Results:Among the 64 patients, 9 patients died of their former diseases or related symptoms. Postoperative follow-up showed that both nutritional status and complications were improved after PEG in 55 patients (P<0.05). The serum albumin and tricep skinfold thickness levels were significantly increased. The incidence of hypoglycemia, hypocalcemia, hypokalemia and hyponatremia were lower than pre-operation. The frequencies of complications were significantly reduced. No severe complications occurred in any patient.Conclusions:Our study confirmed that PEG was a good long-term route of nutritional supply with no serious complications for critically ill patients.

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Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: A systematic review

Cited by 31 publications

References 40 publications

Long‐Term Nasogastric Versus Percutaneous Endoscopic Gastrostomy Tube Feeding in Older Asians With Dysphagia: A Pragmatic Study

Long‐Term Nasogastric Versus Percutaneous Endoscopic Gastrostomy Tube Feeding in Older Asians With Dysphagia: A Pragmatic Study

Clinician's Attitude to Enteral Nutrition with Percutaneous Endoscopic Gastrostomy: A Survey in China

Therapeutic efficacy of nutritional support by percutaneous endoscopic gastrostomy in critically ill patients: A self-control clinical trial

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