The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

Abstract

Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane's Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.

Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review

“…On the basis of our quality evaluations, all included studies exhibited a risk of bias because of ineffective sampling methods, insufficient methodological rigor, and inadequate reporting. In particular, these studies involved a high risk of selection bias because of a lack of randomized sampling [32]. …”

Optimising nutrition support in patients with head and neck cancer

“…There are concerns in the literature that gastrostomy insertion can lead to dysphagia and tube dependency (Chen et al, 2010;Corry et al, 2008;Langmore et al, 2012;Mekhail et al, 2001), although other studies have shown no detrimental impact on swallowing function (Crombie et al, 2015;Silander et al, 2010) and the body of literature remains inconclusive from a recent systematic review (Shaw et al, 2015). Whilst the data from this current study suggests there may have been more tendency for the intervention group to use the tube for supplementary feeding for longer, with an increased use at four months post-treatment, there were no other statistical differences at any other time point.…”

“…Some studies have reported nil impact on swallowing function (Crombie et al, 2015;Silander et al, 2010), and the most recent systematic review on this topic remains inconclusive (Shaw et al, 2015). As there is no agreed definition of the term gastrostomy dependency, its use can therefore be misunderstood (Talwar & Findlay, 2012).…”

“…Tube dependency however was covered by Shaw et al (2015). Five studies examined prevalence of tube use post-treatment (two were in favour of the reactive group, one found no difference, and two did not find any differences beyond three months).…”

“…Two additional systematic reviews have been completed since the Canadian Agency for Drugs and Technologies in Health review (Shaw et al, 2015;Zhang, Zhu, Ling, Zhang, & Wan, 2016). As no new RCT's have been published since those included in the reviews by Langius et al (2013c) and Wang et al (2014a), the new systematic reviews broadened their inclusion criteria to include prospective and retrospective comparative studies, and so have been graded as level III-I (both were considered high quality).…”