Intended for healthcare professionals

Rapid response to:

Clinical Review

Percutaneous endoscopic gastrostomy (PEG) feeding

BMJ 2010; 340 doi: (Published 07 May 2010) Cite this as: BMJ 2010;340:c2414

Rapid Response:

Re: PEG tube feeding after stroke does not improve survival and may worsen functional outcomes

Author’s response

We agree with Professor Dennis summary of the FOOD data. Nevertheless
prior to this there were 2 smaller randomized trials 1,2 which had shown
some clinical benefit with regards to improved nutritional outcomes,
higher likelihood of survival, and earlier discharge. We specifically
cited the FOOD study as we felt this was the most comprehensive work in
this area and we accept that the findings were different to the initial
reports. Our view is very much in concordance with the overview of the
FOOD study – ‘nasogastric feeding early and consider the role of PEG for
patients who cannot tolerate a naso-gastric tube or if patients are
dysphagic for a longer period of time’. 3
The aim of our article was to try and provide an evidence summary for
generalists and our message was that we believe there is a role for PEG in
dysphagic stroke but more importantly perhaps not in other areas where PEG
is being employed.

1. RH Park, MC Allison and J Lang et al., Randomised comparison of
percutaneous endoscopic gastrostomy and nasogastric tube feeding in
patients with persisting neurological dysphagia, BMJ 304 (1992), pp.
2. B Norton, M Homer-Ward, MT Donnelly, RG Long and GK Holmes, A
randomised prospective comparison of percutaneous endoscopic gastrostomy
and nasogastric tube feeding after acute dysphagic stroke, BMJ 312 (1996),
pp. 13–16
3. Donnan GA, Dewey HM. Stroke and nutrition: FOOD for thought. Lancet.
2005 Feb 26-Mar 4;365(9461):729-30.

Competing interests:
None declared

Competing interests: No competing interests

22 May 2010
David S Sanders
Consultant and Honorary Professor in Gastroenterology
Kurien M
S10 2JF