Factors Associated With Gastrostomy Tube Removal in Patients With Dysphagia After Stroke

Abstract

Gastrostomy feeding tubes are commonly placed in patients with dysphagia after stroke. The subsequent removal of the tube is a primary goal during rehabilitation. The purpose of our review was to identify predictors and factors associated with gastrostomy tube removal in patients with dysphagia after stroke. We conducted a literature review following the PRISMA statement and included the search databases PubMed, Scopus, Web of Science, and CINAHL. Articles were included in the final analysis per predefined inclusion and exclusion criteria. Our search retrieved a total of 853 results consisting of 416 articles (after eliminating duplicates). Six articles met our final eligibility criteria. The following factors were identified in at least 1 article as being significantly associated with gastrostomy tube removal: reduced age, decreased number of comorbidities, prolonged inpatient rehabilitation stay, absence of bilateral stroke, nonhemorrhagic stroke, reduced dysphagia severity, absence of aspiration, absence of premature bolus loss, and timely initiation of pharyngeal swallow. Aspiration was the only factor that was investigated by 2 studies-both using multiple regression and both showing stable results, with absence of aspiration increasing the chances for tube removal. In conclusion, little is known about factors associated with gastrostomy tube removal in patients with dysphagia after stroke. Most of the identified factors are associated with stroke or disease severity; however, the role of the individual factors remains unclear. The strongest predictor appears to be absence of aspiration on modified barium swallow studies emphasizing the importance of instrumental swallow studies in this patient population.

Dysphagia: Interprofessional Management, Impact, and Patient‐Centered Care

“…Removal of G tubes was associated with a variety of factors, as found in a review of literature by Wilmskoetter, with the strongest predictor being the absence of aspiration on modified barium swallow. This reflects the importance of ongoing monitoring for improvement in the safety of swallowing so that OI can resume as quickly as it is deemed safe and efficient.…”

Over-the-Scope Clip Closure of Persistent Gastrocutaneous Fistula After Percutaneous Endoscopic Gastrostomy Tube Removal: A Report of Two Cases

“…Enteral nutrition via PEG is indicated in patients with dysphagia [ 3 ]. After the complete resumption of oral intake, the PEG tube can be removed [ 4 ]. Although the gastrostomy site closes spontaneously in most cases after the removal of the PEG tube, persistent gastrocutaneous fistula can occasionally occur [ 1 , 2 ].…”

Caregivers’ Perspectives on the Slight Recovery of Oral Intake of Home‐Dwelling Patients Living With a Percutaneous Endoscopic Gastrostomy Tube: A Qualitative Study Using Focus Group Interviews

“…Patients with an acquired brain injury and their caregivers face a long rehabilitation journey with uncertain potential for recovery. Swallowing rehabilitation may have potential effects on physical and cognitive functions; however, a systematic review of 6 retrospective studies evaluating gastrostomy tube removal after stroke reported “disagreement regarding the majority of predictor or factors across the studies.” Little research has been performed on the effectiveness and related factors of swallowing rehabilitation.…”