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GASTROSTOMY (PERCUTANEOUS ENDOSCOPIC: PEG)IS SAFE AND EFFICACIOUS IN NEUROLOGICAL DYSPHAGIA

Clinical Bottom Lines:

1. In patients with prolonged neurological dysphagia, those fed with percutaneous endoscopic gastrostomy (PEG) feeding receive significantly more nutrition and gain more weight than those fed by nasogastric feeding.

2. Be aware of potential complications: aspiration pneumonia and wound infection.

Appraised by: HN Lee, August 6th 1992

The Evidence: [1] Randomized controlled trial of 40 patients with chronic new neurological dysphagia.

Endpoint

NG feed

PEG

RRR

(relative benefit)

ARR

(absolute benefit)

NNT

Proportion of feed

received

55%

93%

69%

38%

Weight gain in 28 days

0.6 kg

1.5 kg

150%

0.9 kg

Comments:

PEG feeding in 19 patients resulted in two episodes of aspiration pneumonia and one minor wound infection; these are not comparable to nasogastric (NG) feeding because in 18 of 19 patients treatment failed.

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REFERENCES:

Park RHR, Allison MC, Lang J, et al. Randomised comparison of percutaneous endoscopic gastrostomy and naso-gastric feeding in patients with persisting neurological dysphagia. BMJ 1992;304:1406-1409.

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