Abstract
Gastrostomy is recommended for Amyotrophic Lateral Sclerosis (ALS) patients with malnutrition. There are two main methods of gastrostomy insertion: Percutaneous Endoscopic Gastrostomy (PEG) and Fluoroscopic Gastrostomy (FG). The latter included Radiologically Inserted Gastrostomy (RIG) and Per-oral Image-Guided Gastrostomy (PRG). A meta-analysis was conducted to compare these approaches in terms of survival outcomes, pain occurrence and success rate, through the literature search in PubMed, Web of Science and Cochrane Library. A total of 7 studies with 701 cases (322 in PEG, 264 in RIG and 115 in PRG) were enrolled in the final analysis. The lack of differences between the comparisons (PEG vs. PRG, PEG vs. RIG and PEG vs. PRG+RIG) on 30-day mortality and survival length was confirmed. For the pooling analysis of peri- and post-procedural complications, patients with PEG had a lower incidence of pain than cases with PRG and RIG together (P < 0.001). The same trends could be found when compared with PRG and RIG, separately (P < 0.05 and P < 0.001, respectively). And PEG showed a lower rate of successful attempts than PEG and RIG (P < 0.05). For other complications, we didn't find any differences. This meta-analysis demonstrates that PEG, PRG and RIG had their intrinsic advantages. The current evidences could not determine the preference of them. Further investigations should be done to reveal the most appropriate method for ALS patients.
Highlights
Amyotrophic Lateral Sclerosis (ALS) is the most common form of motor neuron disease in adults [1]
We found from the pooling data of 4 studies which compared Percutaneous Endoscopic Gastrostomy (PEG) and Per-oral Image-Guided Gastrostomy (PRG), that there was no significance on 30-day mortality (PEG versus PRG: 4.15% versus 6.09%; odds ratio (OR), 0.81; 95% confidence intervals (CIs), 0.28–2.30; P = 0.69) (Figure 2)
To the best of our knowledge, this meta-analysis is the first to assess the role of different gastrostomy approaches on ALS patients with nutritional difficulties
Summary
Amyotrophic Lateral Sclerosis (ALS) is the most common form of motor neuron disease in adults [1]. During the course of this disorder, malnutrition is common and act as an independent prognostic factor for survival in patients with ALS. Approaches that maintaining a neutral nutritional balance, including altering food consistency, increasing the number of daily meals and use of feeding assistance devices, prevent malnutrition and improve physical functioning, quality of life and survival. It is believed that gastrostomy www.impactjournals.com/oncotarget feeding tube should be placed before respiratory insufficiency develops to improve survival and quality of life. PEG is to be found to have a lower rate of complications, including pain and tube replacement [10]. These controversies might hinder the application among the physicians. We take this meta-analysis to demonstrate it
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