Long-Term Endoscopic Gastrostomy Enteral Feeding of Neurosurgical Patients: A Reference Center Experience

TL;DR

This study examines the use of long-term feeding tubes in neurosurgical patients and finds that most survived at least a month, with better nutrition markers linked to improved outcomes.

Contribution

The study provides a long-term retrospective analysis of PEG feeding outcomes in neurosurgical patients over 22 years.

Findings

Most patients survived more than one month after PEG placement, with 88% surviving beyond one month.

Higher levels of albumin and transferrin at the time of PEG were associated with longer survival and reduced short-term mortality.

Stroke patients made up the majority of surviving PEG-fed patients, and most had normal-to-high BMI despite low serum biomarkers.

Abstract

Background/Objectives: Nutritional support in neurosurgical patients is challenging due to severe brain injury, neurological disease, or post-surgical complications. This study aimed to assess outcomes of long-term enteral nutrition via endoscopic gastrostomy (PEG) in these patients over a 22-year period. Methods: A single-center retrospective (2001–2023) study was conducted on patients referred for PEG. Included patients presented severe traumatic brain injury (TBI), stroke, brain tumor, or other neurosurgical conditions. Demographic, anthropometric, and clinical data were collected. Results: A total of 196 patients were included (105 men); 57% were under 65 years. The main diagnoses were stroke (41.8%), TBI (35.2%), and brain tumors (19.9%). The median time from diagnosis to PEG was 94 days. At the time of PEG, only 38.5% were underweight. Outcomes: A total of 132 deaths (75.4%) occurred, while 21 patients resumed oral feeding (10.7%), 22 patients remained PEG-fed (12.6%), and 21 patients were lost to follow-up (10.7%). Most surviving PEG-fed patients had experienced stroke (77%). Median post-PEG survival was 11.5 months and 88% survived >1 month. Higher albumin, transferrin, and cholesterol levels at the time of PEG were associated with longer survival. Albumin (p < 0.001) and transferrin (p < 0.01) were significantly associated with reduced short-term mortality. Conclusions: Despite limited overall survival, reflecting the clinical severity of the diseases, most patients were adequate survivors, and PEG-feeding proved to be appropriate and useful for neurosurgical patients. While most patients had normal-to-high BMI, low serum biomarkers reflected acute illness. Higher serum albumin level was associated with better outcomes, supporting its potential prognostic value.

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