Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes  

作　　者：Kavya M Reddy Preston Lee Parul J Gor Antonio Cheesman Noor Al-Hammadi David John Westrich Jason Taylor 

机构地区：[1]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 [2]Department of Internal Medicine,Santa Clara Valley Medical Center,San Jose,CA 95128,United States [3]Division of Gastroenterology and Hepatology,Mercy Hospital,Saint Louis,MO 63141,United States [4]David John Westrich,Jason Taylor,Division of Gastroenterology and Hepatology,Saint Louis University School of Medicine,Saint Louis,MO 63104,United States [5]Saint Louis University Center for Health Outcomes Research,Saint Louis University,Saint Louis,MO 63104,United States

出　　处：《World Journal of Gastrointestinal Pharmacology and Therapeutics》2022年第5期77-87,共11页世界胃肠药理与治疗学杂志（英文版）（电子版）

摘　　要：BACKGROUND Percutaneous Endoscopic Gastrostomy(PEG)tubes are often placed for dysphagia following a stroke in order to maintain sufficient caloric intake.The 2011 ASGE guidelines recommend delaying PEG tube placement for two weeks,as half of patients with dysphagia improve within 2 wk.There are few studies comparing outcomes based on timing of PEG tube placement,and there is increasing demand for early PEG tube placement to meet requirements for timely discharge to rehab and skilled nursing facilities.AIM To assess the safety of early(≤7 d post stroke)vs late(>7 d post stroke)PEG tube placement and evaluate whether pre-procedural risk factors could predict mortality or complications.METHODS We performed a retrospective study of patients undergoing PEG tube placement for dysphagia following a stroke at two hospitals in Saint Louis,MO between January 2011 and December 2017.Patients were identified by keyword search of endoscopy reports.Mortality,peri-procedural complication rates,and post-procedural complication rates were compared in both groups.Predictors of morbidity and mortality such as protein-calorie malnutrition,presence of an independent cardiovascular risk equivalent,and presence of Systemic inflammatory response syndrome(SIRS)criteria or documented infection were evaluated by multivariate logistic regression.RESULTS 154 patients had a PEG tube placed for dysphagia following a stroke,92 in the late group and 62 in the early group.There were 32 observed deaths,with 8 occurring within 30 d of the procedure.There was an increase in peri-procedural and post-procedural complications with delayed PEG placement which was not statistically significant.Hospital length of stay was significantly less in patients with early PEG tube placement(12.9 vs 22.34 d,P<0.001).Protein calorie malnutrition,presence of SIRS criteria and/or documented infection prior to procedure or having a cardiovascular disease risk equivalent did not significantly predict mortality or complications.CONCLUSION Early PEG tube placement follow

关 键 词：Percutaneous endoscopic gastrostomy tube DYSPHAGIA Stroke Enteral nutrition Gastrostomy/adverse effect 

分 类 号：R743.3[医药卫生—神经病学与精神病学]