Abstract
Methods: This randomized prospectively controlled trial compared outcome in dysphagic stroke patients based on route of feeding. Patients were recruited over 1 year from general medical and geriatric practices in Britain. Inclusion criteria required an acute cerebrovascular accident in a patient to have resulted in 8 or more days of dysphagia. Patients exclusion required a contraindication to gastrostomy because of gastrointestinal disease or endoscopy. Patients were entered over a 1-year period. Standard methods were used to place nasoenteric tubes or a gastrostomy by a pull through percutaneous technique. A protocol standardized feedings and patient positioning. Outcome measures included mortality at 6 weeks and success in delivering nutritional goals as set by a dietitian.
Results: Thirty patients were recruited: percutaneous endoscopic gastrostomy (PEG) group (n = 16) and nasogastric tube (NG) group (n = 14). All patients were comatose at the time of referral. The mortality rate was high in the NG fed group (57%), consistent with both groups'poor prognosis on entry to the study. The PEG group in contrast had a 6-week mortality of 13% (p <.05). Contributing to the reduction in overall mortality were improved characteristics in the PEG group compared with the NG group: a greater delivery of nutrients, a significant improvement in serum albumin (+0.3 vs -0.9 g/dL, p <.03), midarm circumference (+1 vs -3 cm, p < .03), and weight gain (2.2 vs -2.6 kg, p < .03). Finally, discharge rates at 6 weeks were better in the gastrostomy patients (37%) than in the NG patients (0). All 14 NG patients either died or required ongoing hospitalization at 6 weeks. Two conditions caused the deaths: bronchopneumonia in one and four patients and fatal sequelae of the CVA in one and four patients in the PEG and NG groups, respectively.
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