best management strategy of a PD patient who has laryngeal nerve damage/inability to swallow post CT surgery. Need for PEG for nutrition. ?remove PD catheter and bridge of HD for 4 -6 weeks? Other options? THANKS!

Questions About PD

gretchen brandt, Doctor/MD from washington, dc asked
best management strategy of a PD patient who has laryngeal nerve damage/inability to swallow post CT surgery. Need for PEG for nutrition. ?remove PD catheter and bridge of HD for 4 -6 weeks? Other options? THANKS!

1 answer

MD from USA December 10, 2020

This is a question that seems to come up from time to time, and unfortunately data are limited.  From data in  children there seems to be a difference in starting PD with a PEG tube (PEG before PD) and placing a PEG tube on a patient on PD (PEG after PD).
PEG before PD, in limited studies, seems to be safer than PEG after PD.  In a 2002 study (Lederman et al. Peds Neph 2002), children starting PD with a PEG tube had a peritonitis rate of 0.6 episodes per year, whereas those in the PEG after PD strategy had a much higher rate of infection (1.4 episodes per year).  Prestidge et al (Ped Neph 2015) reported that in 15 patients receiving PEG after PD the rate of peritonitis were 1.21 episodes per patient year compared with 0.6 episodes of patient year prior to PEG placement.  This result was not statistically significant.
Data in adults are limited to case reports.  In one case (Lew et al. PDI 2011), a patient using PEG before PD strategy survived 7 months without PEG related complication or peritonitis.  In another case (Paudel and Fan AJKD 2014) a patient using the PEG after PD strategy had one infection over 12 months, but no other data are provided.
In our institution, continue PD after PEG tube in the patient described, but would advocate for a period of HD with hopeful return to PD when the swallowing issue has resolved.  Again, without the benefit of data, I am not certain the PD catheter needs to be removed if there is a plan to resume PD, but would ensure there is a clear distinction between the PEG and the PD catheter for those caring for the patient.

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