2020 Volume 2 Issue 4 Pages 252-261
Background: The long-term outcomes of artificial nutrition in older people with dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy (ENPEG) and total parenteral nutrition (TPN) are major methods of artificial nutrition in Japan. This study aimed to compare the long-term outcomes between ENPEG and TPN in older persons with dysphagia.
Methods: Subjects were patients who received ENPEG or TPN 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 1-to-1 propensity score matching using a 0.05 caliper.
Results: We identified 253 patients who received ENPEG (n=180) or TPN (n=73). Propensity score matching created 55 pairs. Survival time was significantly longer in the ENPEG group (median, 317 vs 195 days; p=0.017). The hazard ratio for ENPEG 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 ENPEG 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).
Conclusions: ENPEG was associated with a significantly longer survival time and a lower risk of sepsis, but also with a higher incidence of severe pneumonia compared with TPN.
