Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Abstract

BackgroundThe long-term outcomes of artificial nutrition and hydration (ANH) in the elderly with dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy (PEG) and total parenteral nutrition (TPN) are major methods of ANH. Although both can be a life-prolonging treatments, Japan has recently come to view PEG as representative of unnecessary life-prolonging treatment. Consequently, TPN is often chosen for ANH instead. This study aimed to compare the long-term outcomes between PEG and TPN in the elderly.\n\nMethodsThis single-center retrospective cohort study identified 253 elderly patients with dysphagia who received enteral nutrition via PEG (n=180) or TPN (n=73) between January 2014 and January 2017. The primary outcome was survival time. Secondary outcomes were oral intake recovery, discharge to home, and the incidence of severe pneumonia and sepsis. We performed one-to-one propensity score matching using a 0.05 caliper. The Kaplan-Meier method, log-rank test, and Cox proportional hazards model were used to analyze the survival time between groups.\n\nResultsOlder patients with lower nutritional states, and severe dementia were more likely to receive TPN. Propensity score matching created 55 pairs. Survival time was significantly longer in the PEG group (median, 317 vs 195 days; P=0.017). The hazard ratio for PEG relative to TPN was 0.60 (95% confidence interval: 0.39-0.92; P=0.019). There were no significant differences between the groups in oral intake recovery and discharge to home. The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 25.5%, P=0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 30.9%, P=0.018).\n\nConclusionsPEG was associated with a significantly longer survival time, a higher incidence of severe pneumonia, and a lower incidence of sepsis compared with TPN. These results can be used in the decision-making process before initiating ANH.