A Comprehensive Examination of Percutaneous Endoscopic Gastrostomy and Its Association with Amyotrophic Lateral Sclerosis Patient Outcomes.

Leila Bond,Nolan Mallet,Cassie S Mitchell,Paulamy Ganguly,Gloria Bowen,Braden Green,Nishad Khamankar

doi:10.3390/brainsci9090223

Leila Bond, Nolan Mallet + Show 5 more

Open Access

https://doi.org/10.3390/brainsci9090223

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Journal: Brain sciences	Publication Date: Sep 4, 2019
Citations: 30	License type: CC BY 4.0

Affiliation: Georgia Institute of Technology, Emory University

Abstract

There is literature discord regarding the impact of percutaneous endoscopic gastrostomy (PEG), or “feeding tube”, on amyotrophic lateral sclerosis (ALS) outcomes. We assess one of the largest retrospective ALS cohorts to date (278 PEG users, 679 non-users). Kruskal–Wallis and Kaplan–Meier analysis compared cohort medians and survival duration trends. A meta-analysis determined the aggregate associative effect of PEG on survival duration by combining primary results with 7 published studies. Primary results (p < 0.001) and meta-analysis (p < 0.05) showed PEG usage is associated with an overall significant increase in ALS survival duration, regardless of onset type. Percent predicted forced vital capacity (FVC %predict) ≥50 at PEG insertion significantly increases survival duration (p < 0.001); FVC %predict ≥60 has the largest associative benefit (+6.7 months, p < 0.05). Time elapsed from ALS onset until PEG placement is not predictive (p > 0.05). ALSFRS-R survey assessment illustrates PEG usage does not slow functional ALS pathology (p > 0.05), but does stabilize weight and/or body mass index (BMI) (p < 0.05). Observed clinical impression of mood (CIM), was not impacted by PEG usage (p > 0.05). Overall results support PEG as a palliative intervention for ALS patients with ≥50 FVC %predict at PEG insertion.

Highlights

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that damages motor neurons
A common intervention to assist with nutrition and hydration for dysphagic ALS patients experiencing rapid weight decline [1] is a percutaneous endoscopic gastrostomy (PEG)—a procedure where a “feeding tube” is inserted through the abdominal wall directly into the stomach [2,3,4]
The key assessment was to determine the association of PEG usage with ALS survival duration

Summary

Introduction

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that damages motor neurons. Patients eventually develop dysphagia (difficulty swallowing), leading to weight loss or even life-threatening asphyxiation. A common intervention to assist with nutrition and hydration for dysphagic ALS patients experiencing rapid weight decline [1] is a percutaneous endoscopic gastrostomy (PEG)—a procedure where a “feeding tube” is inserted through the abdominal wall directly into the stomach [2,3,4]. PEG slows rapid weight loss and improves patient nutrition [5]. Prevention of rapid weight decline [7] and having a higher pre-morbid body mass index (BMI) [8,9] is thought to positively contribute to survival [10,11]

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