There Is a Need for a Regular Review of Swallowing Ability in Patients after PEG Insertion to Identify Patients with Delayed Recovery of Swallowing

Abstract

Dysphagia is a common complication of stroke, occurring in up to 45% of those admitted to the hospital [1]. Persistent dysphagia is less common, being present in 16% of the survivors after 1 week, 2% at 1 month and 0.4% at 6 months [2]. We report a case where we were able to remove the percutaneous endoscopic gastrostomy (PEG) 649 days after the stroke. An 87-year-old woman was admitted with right hemiplegia and bulbar palsy in March 97. Computed tomography confirmed infarction in the posterior limb of the left internal capsule, with an older infarct just above this on the same side. Speech therapist assessment showed no movement of the tongue, lips, or jaw; absent phonation, either voluntary or reflex; no voluntary cough; and total inability to swallow. The patient required PEG feeding and progressively regained independent mobility by using a delta frame. Three months after the PEG insertion, she was reassessed by the speech therapist who reported some improvement in orofacial control and ability to close lips for short periods but not when attempting to swallow. The swallow reflex could be triggered, but the real problem was in oral control of the bolus. Thickened fluid spilled out, but some was swallowed. The patient was re-referred by her general physician in October 1998 to remove the PEG device. She was consuming a good diet and fluids orally and had put on weight. The tube was successfully removed, and she remains well. Other authors have reported similar cases. Wanklyn et al. [3] showed that three of their six survivors recovered safe swallowing and had the PEG removed between 8 and 102 days. Hull et al. [4], in a study of 45 patients, reported recovery of swallowing in six patients, allowing removal of PEG feeding tube after a mean of 103 days (range 28–224 days). James et al. [5] reported recovery of swallowing in 19% of 126 patients assessed more than 6 months after the PEG insertion, the extremes being 395, 497, and 880 days. There is a clear need for regular review of swallowing ability of patients after PEG insertion because many are discharged to nursing homes and not followed up. This may be most effectively carried out by a community speech therapist.

DOI: 10.1007/s004559910010

Cite this paper

@article{MRCP2000ThereIA, title={There Is a Need for a Regular Review of Swallowing Ability in Patients after PEG Insertion to Identify Patients with Delayed Recovery of Swallowing}, author={H. U. Rehman M.R.C.P. and J. Knox F.R.C.P.}, journal={Dysphagia}, year={2000}, volume={15}, pages={48-48} }