Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in older persons with dysphagia: A propensity-matched cohort study

Abstract

BackgroundThe long-term outcomes of artificial nutrition in older people with dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy (PEG) is one of the major methods of artificial nutrition. Enteral feeding is indicated for patients with a functional gastrointestinal tract. However, total parenteral nutrition (TPN) is often inappropriately chosen for artificial nutrition in Japan, even in patients with a functional gastrointestinal tract, as PEG has recently been viewed as an unnecessary life-prolonging treatment in Japan. This study aimed to compare the long-term outcomes between PEG and TPN.MethodsThis single-center retrospective cohort study investigated long-term outcomes in older patients with dysphagia who received PEG or TPN between January 2014 and January 2017. The primary outcome was survival time. Secondary outcomes were oral intake recovery, discharge to home, and the incidence of severe pneumonia and sepsis. We performed 1-to-1 propensity score matching using a 0.05 caliper. The Kaplan–Meier method, log-rank test, and Cox regression analysis were used to compare the survival time between groups.ResultsWe identified 253 patients who received PEG (n = 180) or TPN (n = 73). Older patients, those with lower nutritional states, and severe dementia were more likely to receive TPN. Propensity score matching created 55 pairs. Survival time was significantly longer in the PEG group (median, 317 vs 195 days; P = 0.017). The hazard ratio for PEG relative to TPN was 0.60 (95% confidence interval: 0.39–0.92; P = 0.019). There were no significant differences between the groups in oral intake recovery and discharge to home. The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 25.5%, P = 0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 30.9%, P = 0.018).ConclusionsPEG was associated with a significantly longer survival time, a higher incidence of severe pneumonia, and a lower incidence of sepsis compared with TPN.

Long‐term prognosis of enteral feeding and parenteral nutrition in a population aged 75 years and older: a population‐based cohort study

“…Because of the nature of the claims this study focused on the survival intervals between the initiation of enteral feeding and PN during hospital admission and death in all the settings, regardless of whether their uses were continued. Considering that previous studies on prognoses of NGT or PN evaluated the periods between initiation and death [ 16 , 35 ], our findings are comparable with those of these studies. However, to address these concerns, further research is needed to clarify the prognoses associated with enteral feeding and PN in patients with different conditions and circumstances.…”

“…They found that the survival period was significantly longer in the PEG group (median, 317 days) than that in the PN group (195 days). Although the study excluded patients with advanced cancer [ 35 ], our study demonstrated better prognoses within 2 years for enteral nutrition than for PN in patients with and without malignant diseases. Moreover, long-term PN places patients at risk for catheter-related blood-stream infections and bacterial translocation [ 35 – 37 ].…”

“…Although the study excluded patients with advanced cancer [ 35 ], our study demonstrated better prognoses within 2 years for enteral nutrition than for PN in patients with and without malignant diseases. Moreover, long-term PN places patients at risk for catheter-related blood-stream infections and bacterial translocation [ 35 – 37 ]. However, in the multivariable analysis, some factors that could influence clinical decisions on nutrition for patients receiving end-of-life care were not adjusted.…”

“…The Cox regression analyses showed that the 2-year mortality rate after the initiation of secondary GS was the lowest compared to that of PN both in the non-malignant and malignancy groups. A previous study that included older patients in Japan, retrospectively compared survival time among patients with dysphagia who required PEG and PN [ 35 ]. They found that the survival period was significantly longer in the PEG group (median, 317 days) than that in the PN group (195 days).…”

Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced

“…Enteral feeding is indicated for patients with a functional gastrointestinal tract, whereas parenteral feeding is more commonly used for patients with nonfunctional gastrointestinal tract [ 10 ]. In general, enteral nutrition is preferred to parenteral nutrition as it is more physiological, simpler, cheaper, and less complicated [ 11 ].…”