PEG Feeding tube placement following a stroke: When to place, when to wait

Background: When to place a percutaneous endoscopic gastrostomy (PEG) feeding tube in acute post-stroke patients remains controversial. The aim of this study was to determine clinical predictors of long-term enteral feeding following a stroke. Method: Medical records of patients at St. Luke's Hospital (Mayo Clinic) from 1995 to 1998 were reviewed for acute stroke that resulted in PEG placement. Comorbid medical illness, stroke subtypes, Glasgow score, swallow evaluation, and time of PEG placement to discontinuation or death were recorded. Results: Thirty-two patients were eligible for study. Mean follow-up was 4 months poststroke. Mean age was 71.3 years. Twenty-five patients had an ischemic stroke, and 7 had primary intracranial hemorrhage. Swallow evaluation was abnormal in 21 of the 23 patients tested. A PEG tube was placed a mean of 8.4 days poststroke in all patients studied. At final follow-up, only 5 surviving patients regained swallowing function in less than 4 weeks and no longer required the PEG. These patients were younger, had mild dysphagia, and had less comorbid medical illness and ischemic strokes compared with the group who did not regain swallow function in 4 weeks. Conclusion: Nonhemorrhagic stroke, mild oropharyngeal dysphagia, limited comorbidities, and younger age help predict patients that may need nutrition support for <4 weeks following a stroke. These patients may best be served with temporary nasogastric feeding tubes.