Stroke: gastrostomy tube feeding decreased treatment failure of patients with dysphagia.

Clinical bottom line (level 1b)

  1. Patients with persisting neurological dysphagia who were given gastrostomy tube feeding, were less likely to have treatment failure, than those given nasogastric tube feeding (NNT = 1 at unknown) .
  2. Patients given gastrostomy tube feeding were more likely to have a longer duration of feeding.
  3. There was no clear difference in complication rates between the two groups.
Park et al: British Medical Journal 1992; 304: 1406-1409
Expires November 2002

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: 3 teaching hospitals, UK

40 patients (aged mean 61 years, 55% male) longstanding dysphagia (> or = 4 weeks) due to neurological disease

Excluded if
  • unstable condition and unlikely to survive at least one month
  • not able to communicate verbally or in writing
  • abnormal gastrointestinal tract
  • dementia
  • mechanical lesions causing obstruction of the oesophagus or stomach
  • active intraabdominal inflammation including inflammatory bowel disease or pancreatitis
  • history of partial gastrectomy, reflux oesophagitis or intestinal obstruction
  • presence of ascites, notable hepatolmegaly, severe obesity, coagulopathy, untreated aspiration pneumonia and major systemic disease including malignancy and respiratory, liver or renal failure


    • Control Group: (n = 20, 20 analysed): nasogastric tube placed in a standard position
    Experimental Group: (n = 20, 19 analysed): gastrostomy tube placed as described by Ponsky and Gauderer.
    Routine antibiotic prophylaxis (cefuroxime 750 mg intramuscularly) was given one hour before tube insertion. Feeding was started the next day if bowel sounds were present. Enteral liquid diets were infused over 24 hours with a volumetric pump, and the volume was tailored to the pateints' needs.
    100% followed for ?
    Outcome notes:
    • treatment failure : blocked or displaced tubes on three or more occasions or refusal to continue treatment

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    treatment failure unknown 18
    (94.7%)    		 0
    (0.00%)    		 100%
    (% to %)    		 94.7%
    (84.7% to 105%)    		 1
    (1 to 1)
    complications unknown 0
    (0.00%)    		 3
    (15.0%)    		 %
    (% to %)    		 -15.0%
    (-30.7% to 0.65%)    		 -7
    (NNT = 154 to infinity;
    NNH = 3 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    mean feeding duration (days) 5.20
    (1.50)     		28.0
    (0.00)     		22.8
    (23.5 to 22.1)

    Citation

    1. Park RHR, Allison MC, Lang J, et al: Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. British Medical Journal 1992; 304: 1406-1409
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer:

    Clinical Question.
    Patient neurological dysphagia
    Intervention or Exposure percutaneous endoscopic gastrostomy
    Comparison nasogastric tube feeding
    Outcome treatment failure