ORIGINAL ARTICLE   

Minerva Gastroenterologica e Dietologica 2020 September;66(3):219-24

DOI: 10.23736/S1121-421X.20.02695-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Effectiveness of percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis

Peter ELBE ¹, Katarina MARKUS ², Roberto VALENTE ¹, Caroline INGRE ³, Apostolos V. TSOLAKIS ¹, Miroslav VUJASINOVIC ¹ ✉

¹ Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; ² Karolinska Institute, Stockholm, Sweden; ³ Department of Neurology, Karolinska University Hospital, Stockholm, Sweden

BACKGROUND: Weight loss and dysphagia are frequent features of amyotrophic lateral sclerosis (ALS) and influence prognosis. The aim of this study was to determine complications and outcomes in patients with percutaneous endoscopic gastrostomy (PEG) insertion in a high-volume center.
METHODS: A single center retrospective study on a prospectively collected cohort of 187 consecutive patients who have undergone PEG placement due to ALS was performed. Demographic and clinical parameters were analyzed.
RESULTS: There were 51.3% male; mean age at insertion was 65.7 years. Major complications occurred in 5 (2.7%) patients: 3 with local infections requiring intravenous antibiotic treatment, 1 patient with PEG dislocation required laparotomy and a new surgically introduced gastrostomy and 1 patient with buried-bumper syndrome. Improvement in Body Mass Index (BMI) and serum albumin levels were recorded in 37.3% and 51.9%, respectively. Mortality after 30 days, 6 months and 12 months was 5.3%, 38% and 64.3%, respectively. At the time of data collection, 78.9% of the patients had died. Mean survival after ALS diagnosis was 20.5 months.
CONCLUSIONS: PEG placement is as an effective, safe nutritional method with a low complication rate in patients with ALS, with or without non-invasive ventilation. The BMI and albumin levels stabilize after PEG placement, indicating benefits of early placement.

KEY WORDS: Endoscopy; Gastrostomy; Amyotrophic lateral sclerosis; Complications