[Percutaneous endoscopic gastrostomy in a myotrophic lateral sclerosis. Experience in a district general hospital].

Abstract

BACKGROUND:

Amyotrophic Lateral Sclerosis (ALS) is a degenerative disorder that affects the pyramidal tract, producing progressive motor dysfunctions leading to paralysis. These patients can present with dysphagia, requiring nutritional support with a nasogastric tube or Percutaneous Endoscopic Gastrostomy (PEG). PEG is associated with increased survival rates. However, the timing of PEG placement remains a significant issue for clinicians.

OBJECTIVE:

To analyse the characteristics of ALS patients at the moment of PEG placement and their progression.

METHODS AND MATERIALS:

Descriptive retrospective study including patients diagnosed with ALS and PEG who were assessed during the 2005-2014 period in our hospital. Nutritional parameters and respiratory function were assessed for all patients, as well as their progression. The data was analysed using SPSS15.

RESULTS:

37 patients were included (56.8% men, 43.2% women) with an average age of 60 at diagnosis, and an average age of 63.1 at PEG placement. 48.6% started with spinal affection and 51.4%, with bulbar affection. 43.2% of the patients received oral nutritional supplements prior to PEG placement for a mean period of 11.3 months. The mean forced vital capacity at diagnosis was 65.45±13.67%, with a negative progression up to 39.47±14.69% at the moment of PEG placement. 86.5% of patients required non-invasive positive-pressure ventilation. 86.5% presented with dysphagia, 64.9% with weight loss > 5-10% from their usual weight, 8.1% with low Body Mass Index, 27% with malnutrition and 73% with aworsened breathing function; therefore, 100% met the criteria for PEG placement according to our protocol. The period on enteral feeding was extended for 10.1 months with a mortality of 50% during the first 6 months from PEG placement.

CONCLUSIONS:

There is evidence of a 3-year delay between diagnosis and PEG placement, with a survival rate of 50% at 6 months from PEG insertion. Further studies are required to establish whether an earlier placement might increase survival rates.

• Authors: Inmaculada Prior-Sánchez, Aura Dulcinea Herrera-Martínez, Carmen Tenorio Jiménez, María José Molina Puerta, Alfonso Jesús Calañas Continente, Gregorio Manzano García, María Ángeles Gálvez Moreno
• Journal: Nutricion hospitalaria (Nutr Hosp) Vol. 30 Issue 6 Pg. 1289-94 (Dec 01 2014) ISSN: 1699-5198 [Electronic] Spain
• Vernacular Title: Gastrostomía endóscopica percutánea en esclerosis lateral amiotrófica; experiencia en un hospital de tercer nivel.
• PMID: 25433110 (Publication Type: Journal Article)
• Copyright: Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Topics

• Aged
• Amyotrophic Lateral Sclerosis (complications, surgery)
• Deglutition Disorders (etiology, surgery)
• Endoscopy (methods)
• Female
• Gastrostomy (methods)
• Hospitals, General
• Humans
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures
• Retrospective Studies
• Spain
• Survival Analysis