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PEG Dependence May Inhibit Swallowing Post-Irradiation

by Christine G. Gourin, MD •

Does percutaneous endoscopic gastrostomy (PEG) use cause dysphagia in head and neck cancer patients?

Background: PEG use is common in patients who undergo radiotherapy for head and neck cancer to maintain weight and nutrition during treatment. However, the true effect of PEG use on weight maintenance and its potential impact on long-term dysphagia outcomes have not been adequately studied.

Study design: Retrospective review.

Setting: Boston University Medical Center, Boston, Mass.

Synopsis: The study population comprised 59 patients who underwent radiation therapy for head and neck cancer and who had complete swallowing data and no evidence of recurrent disease. Of these patients, 33 (56 percent) had a PEG placed prophylactically. The percentage of weight loss and mean diet scores were assessed at the end of radiation and at three, six and 12 months post-radiation. PEG use was documented in 26 percent of patients at three months after the completion of radiation, 24 percent at six months and 15 percent at 12 months.

All patients lost weight during treatment. There was no difference in the long-term percentage of weight change between the prophylactic PEG patients and all other participants, or between patients who had oral diets and those with partially oral diets or those who were NPO during radiation (p=0.19). However, those who did not receive prophylactic PEG placement and those who maintained an oral or a partially oral diet during radiation had significantly better mean diet scores at all times post-radiation, with patients who underwent prophylactic PEG having significantly lower mean diet scores compared with those who did not (ß= -1.11, 95 percent CI -1.78-0.44, p=0.002).

Bottom line: PEG dependence may lead to adverse swallowing ability in post-irradiated head and neck cancer patients, which may be due to decreased use of the swallowing musculature.

Reference: Langmore S, Krisciunas GP, Miloro KV, Evans SR, Cheng DM. Does PEG use cause dysphagia in head and neck cancer patients? Dysphagia. 2012;27(2):251-259.