PREDICTIVE FACTORS FOR REMOVAL OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE IN POST-STROKE DYSPHAGIA

Objective: To investigate predictive factors for percutaneous endoscopic gastrostomy (PEG) removal, thereby minimizing unnecessary PEG insertion in post-stroke dysphagia. Design: Retrospective cohort study. Patients: A total of 49 patients who undertook PEG tube insertion for post-stroke dysphagia. Methods: Patients were divided into a removal group (n=8) and a sustaining group (n=41) depending on the presence of a PEG tube. Patients' demographic data, nutritional status, Charlson's Comorbidity Index (CCI), and video-fluoroscopic swallowing study findings at the time of PEG insertion were compared between the 2 groups. Results: Eight out of 49 patients (16.3%) removed the PEG tube at a mean of 4.8 months after the insertion. Demographic data, nutritional status, and CCI were comparable between the 2 groups before tube insertion. Video-fluoroscopic swallowing study findings in the removal group showed a lower prevalence of premature bolus loss (50.0% vs 73.2%; p=0.032), aspiration (37.5% vs 80.6%; p=0.012) and pharyngeal trigger delay (12.5% vs 74.2%; p=0.010) than those in the sustaining group. Conclusion: The absence of aspiration or pharyngeal trigger delay in video-fluoroscopic swallowing study findings at the time of PEG insertion may be a predictive factor for eventual removal of PEG tubes. Identification of removal factors will assist in determining PEG insertion.