title: A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people.
abstract: OBJECTIVE
  To compare the indications for and the outcome of long-term enteral feeding by nasogastric tube (NGT) with that of percutaneous endoscopic gastrostomy (PEG) tube.
  
  
  METHODS
  A prospective, multicenter cohort study.
  
  
  METHODS
  Acute geriatric units and long-term care (LTC) hospitals in Jerusalem, Israel.
  
  
  METHODS
  122 chronic patients aged 65 years and older for whom long-term enteral feeding was indicated as determined by the treating physician. Patients with acute medical conditions at the time of tube placement were excluded.
  
  
  METHODS
  We examined the indications for enteral feeding, nutritional status, outcome and complications in all subjects. Subjects were followed for a minimum period of six months.
  
  
  RESULTS
  Although the PEG patients were older and had a higher incidence of dementia, there was an improved survival in those patients with PEG as compared to NGT (hazard ratio (HR)=0.41; 95% confidence interval (CI) 0.22-0.76; P=0.01). Also, the patients with PEG had a lower rate of aspiration (HR=0.48; 95% CI 0.26-0.89) and self-extubation (HR=0.17; 95% CI 0.05-0.58) than those with NGT. Apart from a significant improvement in the serum albumin level at the 4-week follow-up assessment in the patients with PEG compared to those with NGT (adjusted mean 3.35 compared to 3.08; F=4.982), nutritional status was otherwise similar in both groups.
  
  
  CONCLUSIONS
  In long-term enteral feeding, in a selected group of non-acute patients, the use of PEG was associated with improved survival, was better tolerated by the patient and was associated with a lower incidence of aspiration. A randomized controlled study is needed to determine whether PEG is truly superior to NGT.
authors.affiliation: Department of Geriatric Medicine, Shaare Zedek Medical Center, Jesuralem, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Dwolatzky
authors.forename: S
authors.initials: S
authors.lastname: Berezovski
authors.forename: R
authors.initials: R
authors.lastname: Friedmann
authors.forename: J
authors.initials: J
authors.lastname: Paz
authors.forename: A M
authors.initials: AM
authors.lastname: Clarfield
authors.forename: J
authors.initials: J
authors.lastname: Stessman
authors.forename: R
authors.initials: R
authors.lastname: Hamburger
authors.forename: E
authors.initials: E
authors.lastname: Jaul
authors.forename: Y
authors.initials: Y
authors.lastname: Friedlander
authors.forename: A
authors.initials: A
authors.lastname: Rosin
authors.forename: M
authors.initials: M
authors.lastname: Sonnenblick
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004724:Endoscopy; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome