ABSTRACT
Dysphagia in the palliative or terminal care setting can be caused by neuro-muscular conditions, lesions in the head and neck area and malignant obstruction of the upper gastrointestinal tract. Tube feeding with percutaneous endoscopic gastrostomy (PEG) or nasogastric (NG) tube is indicated in stroke and motor neuron disease but should be avoided in dementia. Head and neck cancers often require tube feeding and NG tube results are favourable to those of PEG or radiologically introduced gastrostomy placement, which is however preferred by patients. Long-term palliation of symptoms from oesophageal lesions is best achieved with radiotherapy, but stents have favourable short-term outcomes albeit at the expense of more late complications. Gastric outlet obstructions can be treated effectively with stents but late complications are also common. Surgical gastrojejunostomy provides better long-term results, but causes delayed gastric emptying in the early postoperative phase. It also requires a longer hospital stay and fitness to undergo surgery. Life expectancy – which is often difficult to estimate in a palliative setting – plays a major role in the decision-making process: Patients with a life expectancy of less than 3 months should be offered stents rather than alternative treatments. Local availability of treatments and side effect profiles of the different treatments should however also be taken into account.
