Endoscopy 2020; 52(S 01): S49
DOI: 10.1055/s-0040-1704152
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 14:30 – 16:00 Quality in gastroscopy: Raising the bar Wicklow Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN PATIENTS WITH ACUTE STROKE. EARLY OR DELAYED PLACEMENT?

E Orfanoudaki
1   University Hospital of Heraklion, Gastroenterology, Heraklion, Greece
,
I Drygiannakis
1   University Hospital of Heraklion, Gastroenterology, Heraklion, Greece
,
A Augoustaki
1   University Hospital of Heraklion, Gastroenterology, Heraklion, Greece
,
E Stamatopoulos
1   University Hospital of Heraklion, Gastroenterology, Heraklion, Greece
,
S Ioannidis
2   University Hospital of Heraklion, Neurology, Heraklion, Greece
,
P Mitsias
2   University Hospital of Heraklion, Neurology, Heraklion, Greece
,
M Koulentaki
1   University Hospital of Heraklion, Gastroenterology, Heraklion, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

 

Aims Percutaneous endoscopic gastrostomy (PEG) is indicated for patients with acute stroke and anticipated prolonged dysphagia for more than 28 days. The most favorable time for PEG placement is controversial. We aim to present our experience on the management of patients with acute stroke and dysphagia.

Methods As part of a clinical protocol, all patients admitted in the Neurology department of our hospital, from 11/2017-11/2019 for acute stroke and dysphagia were assessed. Patients eligible for PEG were scheduled for placement 28 days from the initial episode. PEG tubes 20-24Fr were placed (pull technique). Meanwhile enteral feeding was provided through nasogastric tubes. Early and long-term complications as well as outcome and mortality were recorded.

Results A total of 99 consecutive stroke patients with dysphagia were assessed [median(IQR) age 82(16.3) years, 55% female]. Ninety-four consented for PEG placement. The procedure was scheduled 34.5 (11.8) days after the stroke. Only 40.9% of the scheduled endoscopies were performed and PEG was placed in 34.4% of the patients originally assessed (84% of those scoped) all receiving aspirin. At the time of the appointment 28% have already recovered swallowing, 15% were deceased, 11% were lost follow-up, while in 6.5% PEG could not be placed due to lack of transillumination and endoscopically visible focal finger invagination (referral to surgical or radiologic PEG placement). In the follow-up period of 13.3 (10) months, 12.5% of those with PEG experienced early complications (3 hemorrhage, 1 respiratory tract infection), while 15% experienced late complications (1 buried bumper syndrome, 2 peri-stomal abscesses, 2 accidental removals). Two patients regained functional swallowing and PEG was removed.

Conclusions PEG placement in patients with stroke is safe and successful. Immediate placement after acute stroke does not appear cost-effective over delayed since almost half (43%) of the patients either regained functional swallowing or died due to disease severity within 30 days.