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Dysphagia

, Volume 30, Issue 2, pp 152–175 | Cite as

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

  • Stephanie M. ShawEmail author
  • Heather Flowers
  • Brian O’Sullivan
  • Andrew Hope
  • Louis W. C. Liu
  • Rosemary Martino
Original Article

Abstract

Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane’s Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.

Keywords

Deglutition and deglutition disorders Head and neck cancer Radiotherapy Prophylactic Feeding tube Percutaneous endoscopic gastrostomy (PEG) 

Notes

Acknowledgments

The authors would like to thank Dr. Yoko Inamoto (Fujita Health University, Faculty of Rehabilitation) for her help with article translation.

Supplementary material

455_2014_9592_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 42 kb)
455_2014_9592_MOESM2_ESM.docx (736 kb)
Supplementary material 2 (DOCX 736 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Stephanie M. Shaw
    • 1
    Email author
  • Heather Flowers
    • 1
  • Brian O’Sullivan
    • 2
  • Andrew Hope
    • 2
  • Louis W. C. Liu
    • 3
  • Rosemary Martino
    • 1
    • 4
    • 5
  1. 1.Department of Speech-Language Pathology, Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoCanada
  3. 3.Division of Gastroenterology, Toronto Western HospitalUniversity Health NetworkTorontoCanada
  4. 4.Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoCanada
  5. 5.Health Care and Outcomes Research, Toronto Western Research InstituteUniversity Health NetworkTorontoCanada

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