Background And Purpose: Swallowing difficulties are common poststroke. National clinical guidelines recommend feeding by percutaneous endoscopic gastrostomy (PEG) when oral nutrition cannot be maintained although survival benefit might be short term. It is unknown whether a decade of general care improvements have impacted upon PEG provision and outcomes. This retrospective cohort study examined PEG placement and mortality poststroke in England.
Methods: National Health Service Hospital Episode Statistics and Office for National Statistics mortality data between April 2007 and March 2018 were linked to identify all admissions in England with stroke-related codes (I61, I63, and I64)±PEG insertion and deaths at 3, 6, and 12 months. Linear and logistic regression examined trends over time and mortality.
Results: Patients (923 236) with stroke underwent 17 532 PEG procedures (mean rate 1.9%), with an average reduction of -27 procedures/year ([95% CI, -56 to 1.4]; =0.06) despite an average increase of 1804 stroke admissions/year. Mortality decreased among cases without a PEG procedure: -190 deaths/year ([95% CI, -276 to -104]; <0.001) at 3 months, -167 deaths/year ([95% CI, -235 to -98]; <0.001) at 6 months and -103 deaths/year ([95% CI, -157 to -50]; <0.01) at 12 months; and also reduced following PEG insertion: -28 deaths/year ([95% CI, -35 to -20]; <0.001) at 3 months, -33 deaths/year ([95% CI, -46 to -20]; <0.01) at 6 months and -30 deaths/year ([95% CI, -48 to -13]; <0.01) at 12 months. With all years combined, PEG insertion was weakly associated with reduced mortality at 3 months (odds ratio, 0.94 [95% CI, 0.90-0.97]) but significantly higher mortality at 6 months (odds ratio, 1.69 [95% CI, 1.64-1.75]) and 12 months (odds ratio, 2.14 [95% CI, 2.08-2.20]).
Conclusions: PEG procedures and subsequent deaths have decreased in the context of general mortality reductions after hospitalization for stroke, but survival at 6 and 12 months remains significantly worse for patients with PEG placement.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1161/STROKEAHA.120.030502 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Surgical Step-Up Approach in Management of Necrotizing Pancreatitis.
Gastroenterol Clin North Am
March 2025
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Necrotizing pancreatitis often demands intervention; contemporary management is directed by the step-up approach. Timing of intervention and specific approach is best directed by a multi-disciplinary team including advanced endosocpists, interventional radiologists, and surgeons with interest and experience managing this complex problem. The intervention is often a combination of percutaneous drainage, transluminal endoscopic approaches, and surgical debridement (minimally invasive or open).
View Article and Find Full Text PDFEndoscopic Step-Up Approach in Management of Necrotizing Pancreatitis.
Gastroenterol Clin North Am
March 2025
Department of Gastroenterology, Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, India. Electronic address:
The endoscopic step-up approach in the management of necrotizing pancreatitis involves sequential steps of intervention at different time points in the clinical course of the disease. EUS -guided drainage of walled-off necrosis is the first step of the endoscopic step-up approach. Lumen-apposing metal stents are preferred over plastic stents for safe and effective drainage because of their wide caliber.
View Article and Find Full Text PDFEvidence-Based Framework for Surgical Irrigation Fluid Stewardship and Endoscopic Case Prioritization During Fluid Shortages.
Urol Pract
January 2025
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Introduction: The US supply disruption of surgical irrigation fluids in September 2024 prompted the need for fluid conservation and potential deferral of urology procedures. We characterized fluid use in common endoscopic procedures to articulate recommendations for irrigation fluid stewardship and case prioritization during fluid shortages.
Methods: We reviewed case volumes and irrigation fluid use for endoscopic urological procedures at our institution during January-September 2024.
Impact of severe dysphagia on overall survival after percutaneous endoscopic gastrostomy.
Sci Rep
January 2025
Department of Gastroenterology, Omi Medical Center, 1660 Yabase-cho, Kusatsu, 525- 8585, Shiga, Japan.
In this study, we investigated the effect of severe dysphagia on the overall survival of patients who underwent PEG. A cohort of patients who underwent PEG between April 2016 and April 2021 was retrospectively analyzed. The Hyodo-Komagane score was used to evaluate swallowing via endoscopy.
View Article and Find Full Text PDFClinical evaluation of endoscopic biliary stenting in treatment of malignant obstructive jaundice.
World J Gastrointest Surg
January 2025
Department of General Surgery, Shenzhen University General Hospital, Shenzhen 518000, Guangdong Province, China.
Background: Malignant obstructive jaundice (MOJ) is characterized by the presence of malignant tumors infiltrating or compressing the bile duct, causing poor bile drainage, generalized yellowing, pain, itching, and malaise. MOJ is burdensome for both the society and the families of affected patients and should be taken seriously.
Aim: To evaluate the clinical effect of stent placement during endoscopic retrograde cholangiopancreatography for relieving MOJ and the efficacy of percutaneous transhepatic biliary drainage in terms of liver function improvement, complication rates, and long-term patient outcomes.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!