Prophylactic PEG Tube and Swallowing Following Chemoradiation

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

“…Thirteen studies used standardized measurement tools to assess swallowing-related outcomes: four used quality of life scales with swallowing-related questions [71,72,94,96], seven used scales that specifically measure swallow function and/or quality of life in patients with head and neck cancer [50,83,84,86,[92][93][94], two used generic dysphagia assessment scales that measure swallow-related function based on clinician and/or patient report [84,94], and one used radiation-related toxicity scales that measure swallow-related function based on physician report [87]. Four additional studies used diet level to assess swallow function [67,72,88,94], three failed to report how dysphagia was assessed [44,90,95], and four only reported on PEG prevalence/duration as a surrogate marker of dysphagia [46,85,89,91]. The timing of dysphagia assessment also varied across studies (see Tables 3 and 4).…”

“…Eight studies measured dysphagia frequency and/or severity at multiple time points [22,67,71,72,84,87,88,95]. Fifteen studies evaluated swallowing during the chronic phase (C3 months posttreatment) [22, 50, 67, 71, 72, 83, 84, 86-88, 90, 92-95], with 11 evaluating swallowing at C12 months post treatment [22,67,71,72,83,84,88,[92][93][94][95] and eight evaluating dysphagia at C2 years post treatment [71,72,83,84,87,[92][93][94]. One additional study did not report on the timing of dysphagia assessment [44].…”

“…Two of the 20 studies were randomized controlled trials (RCTs) [71,72] (see Table 1), one followed a case-control design [83], and the remaining 17 involved observational cohorts (three prospective [84][85][86], nine retrospective [22,44,67,[87][88][89][90][91][92], three mixed (with some outcomes being retrieved retrospectively and others being collected prospectively) [46,93,94], and two unclear [50,95]). …”

“…Four studies used IMRT [50,[85][86][87], two used 3DCRT [88,92], one used conventional radiotherapy [46], four used various forms of radiotherapy [22,67,90,91], and nine were unclear regarding the type of radiotherapy used [44,71,72,83,84,89,[93][94][95] (see Table 1). …”

“…Seven studies included patients who either received no PEG or a therapeutic PEG as needed [67,72,84,85,87,91,93], three included only patients who received a therapeutic PEG (placed during or after radiotherapy) [44,89,94], one included patients who either had a therapeutic PEG or an NG tube as needed [88], and two included patients who either maintained oral nutrition or received an NG tube as needed [83,92]. The remaining five studies were unclear regarding their requirements for inclusion within the control group (although the majority included at least some patients managed with a therapeutic PEG [22,50,71,86,95]; see Table 1). …”