Skip to main content Accessibility help
×
Home

Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement after Stroke

  • Jian Li (a1), Juan Zhang (a1), Shujuan Li (a1), Hongliang Guo (a1), Wei Qin (a1) and Wen li Hu (a1)...

Abstract

Aims:

the goal of this study was to identify important prognostic variables affecting placement of a percutaneous endoscopic gastrostomy (Peg) tube after acute stroke.

Methods:

We retrospectively reviewed our patient database to identify acute ischemic stroke patients who placed Peg or nasogastric tube (Ngt) tube, but were free of other confounding conditions affecting swallowing. A total of 340 patients were involved in our study. We assessed the influence of age, National Institutes of Health stroke scale (NIHss) score, infarct volume, stroke subtype based on the toAst criteria, swallowing disorders, bilateral lesions in cerebrum and length of stay (los) in a logistic regression analysis.

Results:

In univariate analysis, age (p=0.048), NIHss score (p<0.0001), lesion volume (p<0.0001), los (p<0.0001), stroke location (p=0.045), and swallowing disorders (p<0.0001) were found to be the primary predictors of placing Peg. the presence of lesions in bilateral cerebral was included in the final model based on clinical considerations. After multivariate adjustment, only NIHss score (odds ratio [oR], 4.055; 95% confidence interval [CI], 2.398-6.857; p=0.0001), lesion volume (oR, 1.69; 95%CI, 1.09–4.39; p=0.014), swallowing disorders (oR, 1.151; 95% CI, 1.02-1.294; p=0.047), los (oR, 0.955; 95% CI, 0.914-0.998; p=0.0415) and bilateral lesions (oR, 2.8; 95% CI, 1.666-4.705; p=0.0001) remained significant.

Conclusion:

our data shows that NIHss score, lesion volume, swallowing disorders, los and bilateral lesions in cerebrum can predict the requiring of Peg tube insertion in patients after stroke.

RÉSUMÉ

Facteurs de prédiction de la mise en place d'un tube de gastrostomie par endoscopie percutanée après un accident vasculaire cérébral.

Objectifs:

Le but de cette étude était d'identifier les variables importantes du pronostic influençant la mise en place d'un tube de gastrostomie par endoscopie percutanée après un accident vasculaire cérébral aigu.

Méthode:

Nous avons revu rétrospectivement notre base de données pour identifier les patients atteints d'un AVC ischémique aigu, chez qui un tube nasogastrique ou un tube de gastrostomie par endoscopie percutanée avait été mis en place, mais qui ne présentaient pas d'autres problèmes touchant la déglutition. Notre étude porte sur 340 patients. Nous avons étudié au moyen d'une analyse de régression logistique l'influence de l'âge, le score au National Institutes of Health Stroke Scale (NIHSS), le volume de l'infarctus, le sous-type d'AVC selon les critères TOAST, les problèmes de déglutition, les lésions bilatérales au niveau des hémisphères cérébraux et le temps d'hospitalisation (TH).

Résultats:

À l'analyse univariée, l'âge (p = 0,048), le score au NIHSS (p < 0,0001), le volume de la lésion (p < 0,0001), le TH (p < 0,0001), l'endroit de l'AVC (p = 0,045) et les troubles de la déglutition (p < 0,0001) étaient les principaux facteurs de prédiction de la mise en place d'un tube de gastrostomie. La présence de lésions cérébrales bilatérales était incluse dans le modèle fmal pour des raisons cliniques. Après ajustement multivarié, seuls le score NIHSS (rapport de cotes [RC] 4,055 ; intervalle de confiance [ICI à 95% de 2,398 à 6,857 ; p = 0,0001), le volume de la lésion (RC 1,69 ; IC à 95% de 1,09 à 4,39 ; p = 0,014), les troubles de la déglutition (RC 1,151 ; IC à 95% de 1,02 à 1,294 ; p = 0,047), le TH (RC 0,955 ; IC à 95% de 0,914 à 0,998 ; p = 0,0415) et les lésions bilatérales (RC 2,8 ; IC à 95% de 1,666 à 4,705 ; p = 0,0001 demeuraient significatifs.

Conclusion:

Nos données démontrent que le score au NIHSS, le volume de la lésion, les troubles de la déglutition, le TH et la présence de lésions bilatérales dans les hémisphères cérébraux peuvent prédire la nécessité de mettre en place un tube de gastrostomie par endoscopie percutanée chez les patients atteints d'un AVC.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement after Stroke
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement after Stroke
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement after Stroke
      Available formats
      ×

Copyright

Corresponding author

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Beijing 100020, China. Email: huwenli@sina.com.

References

Hide All
1. Haywood, S. PEG feeding tube placement and aftercare. Nurs Times. 2012;108:202.
2. Potack, JZ, Chokhavatia, S. Complications of and controversies associated with percutaneous endoscopic gastrostomy: report of a case and literature review. Medscape J Med. 2008;10:142.
3. Alshekhlee, A, Ranawat, N, Syed, TU, Conway, D, Ahmad, SA, Zaidat, OO. National Institutes of Health Stroke Scale assists in predicting the need for percutaneous endoscopic gastrostomy tube placement in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2010;19:34752.
4. Dennis, MS, Lewis, SC, Warlow, C, et al. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): A multicentre randomised controlled trial. Lancet. 2005;365:76472.
5. Panos, MZ, Reilly, H, Moran, A, et al. Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs. Gut. 1994;35:15516.
6. Gomes, CAR Jr, Lustosa, SAS, Matos, D, Andriolo, RB, Waisberg, DR, Waisberg, J. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database of Systematic Reviews 2012, Issue 3.
7. Dwolatzky, T, Berezovski, S, Friedmann, R, et al. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people. Clin Nutr. 2001;20:53540.
8. John, B, Jesper, L, Lena, M, et al. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroentero. 2012;47:73742.
9. Somi, MH, Maghbouli, L, Antikchi, M. Acceptability and outcomes of percutaneous endoscopic gastrostomy (PEG) tube placement and patient quality of life. Turk J Gastroenterol. 2011;22:12833.
10. Dwolatzky, T, Berezovski, S, Friedmann, R, et al. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people. Clin Nutr. 2001;20:53540.
11. Norton, B, Homer-Ward, M, Donnelly, MT, Long, RG, Holmes, GK. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ. 1996;312:136.
12. Hilker, R, Poetter, C, Findeisen, N, et al. Nosocomial pneumonia after acute stroke: Implications for neurological intensive care medicine. Stroke. 2003;34:97581.
13. El Solh, A, Okada, M, Bhat, A, Pietrantoni, C. Swallowing disorders post orotracheal intubation in the elderly. Intensive Care Med. 2003;29:14515.
14. Kumar, S, Langmore, S, Goddeau, RP Jr, et al. Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction. J Stroke Cerebrovasc Dis. 2012;21:11420.
15. Bates, B, Choi, JY, Duncan, PW, et al. Veterans Affairs/Department of Defense clinical practice guideline for the management of adult stroke rehabilitation care: Executive summary. Stroke. 2005;36: 204956.
16. Martin, RE, Goodyear, BG, Gati, JS, Menon, RS. Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol. 2001;85:93850.
17. Ertekin, C, Aydogdu, I. Neurophysiology of swallowing. Clin Neurophysiol. 2003;114:222644.
18. Reisberg, B, Ferris, SH, Georgotas, A, et al. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139:11369.
19. Sims, JR, Gharai, LR, Schaefer, PW, et al. ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology. 2009;72:210410.
20. Pedraza, S, Puig, J, Blasco, G. Reliability of the ABC/2 method in determining acute infarct volume. J Neuroimaging. 2012;22:1559.
21. Hamdy, S, Aziz, Q, Rothwell, JC, et al. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke Lancet. 1997;350:68692.
22. Osawa, A, Maeshima, S, Matsuda, H, Tanahashi, N. Functional lesions in dysphagia due to acute stroke: discordance between abnormal findings of bedside swallowing assessment and aspiration on videofluorography. Neuroradiology. 2013;55:41321.
23. Baba, Y, Teramoto, S, Hasegawa, H, Machida, A, Akishita, M, Toba, K. Characteristics and limitation of portable bedside swallowing test in elderly with dementia: comparison between the repetitive saliva swallowing test and the simple swallowing provocation test. Nihon Ronen Igakkai Zasshi. 2005;42:3237.
24. Osawa, A, Maeshima, S, Tanahashi, N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovasc Dis. 2013;35:27681.
25. Hamdy, S, Aziz, Q, Rothwell, JC, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology. 1998;115:110412.
26. Johnston, KC, Wagner, DP, Wang, XQ, et al. Validation of an acute ischemic stroke model: Does diffusion-weighted imaging lesion volume offer a clinically significant improvement in prediction of outcome? Stroke. 2007;38:18205.
27. Daniels, SK, Foundas, AL. Lesion localization in acute stroke patients with risk of aspiration. Neuroimaging. 1999;9:918.
28. Turhan, N, Atalay, A, Muderrisoglu, H. Predictors of functional outcome in first-ever ischemic stroke: A special interest to ischemic subtypes, comorbidity and age. NeuroRehabilitation. 2006;24:3216.
29. Thijs, VN, Lansberg, MG, Beaulieu, C, et al. Is early ischemic lesion volume on diffusion-weighted imaging an independent predictor of stroke outcome? A multivariable analysis. Stroke. 2000;31:2597602.
30. Lindsell, CJ, Alwell, K, Moomaw, CJ, et al. Validity of a retro spective National Institutes of Health Stroke Scale scoring methodology in patients with severe stroke. J Stroke Cerebrovasc Dis. 2005;14:2813.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed