Clinical Factors Associated With Successful Gastrostomy Tube Weaning in Patients With Prolonged Dysphagia After Stroke

Abstract

Objective To investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke. Methods This study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients' demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated. Results There were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634-0.987) and PAS scores (OR=0.205; 95% CI, 0.059-0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively. Conclusion In patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning.

Predictors of complete oral feeding resumption after feeding tube placement in patients with stroke and dysphagia: A systematic review

“…Thirteen studies (Ickenstein et al, 2003, Lin et al, 2005, Oto et al, 2009, Krieger et al, 2010, Yi et al, 2012, Maeshima et al, 2013, Crisan et al, 2014, Nakadate et al, 2016, Nishioka et al, 2017, Calvo et al, 2019, Wilmskoetter et al, 2019, Hsueh et al, 2020, Jang et al, 2021) examined the predictive effect of demographic characteristics on complete oral feeding resumption.…”

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“…Despite the abundant body of sources regarding G-tube weaning in pediatric patients, information on weaning in adult patients remains scarce with no existing benchmark for G-tube weaning [65]. However, similar to children, G-tube complications emphasize the need for proper weaning procedure.…”

“…However, similar to children, G-tube complications emphasize the need for proper weaning procedure. In adults specifically, complications such as granuloma formation and local infection are of more concern compared to psychological complications which are more common in children [65]. A 2021 retrospective study by Jang et.…”

“…A 2021 retrospective study by Jang et. al reported age and history of aspiration pneumonia as factors influencing the success of the weaning process in patients with dysphagia following a stroke [65]. Patient results on the Functional Dysphagia Score (FDS) and Penetration-Aspiration Score (PAS) correlated to their success with gastrostomy tube weaning as both indicated the severity of the patient's dysphagia [65,66,67].…”

“…al reported age and history of aspiration pneumonia as factors influencing the success of the weaning process in patients with dysphagia following a stroke [65]. Patient results on the Functional Dysphagia Score (FDS) and Penetration-Aspiration Score (PAS) correlated to their success with gastrostomy tube weaning as both indicated the severity of the patient's dysphagia [65,66,67]. Despite the study pertaining to the weaning process in adults, dysphagia is an important factor in determining the success of G-tube weaning among pediatric patients as well, further highlighting the complex and multifactorial nature of the weaning process.…”