1. 1: Houston Methodist Neurological Institute, Houston, TX
Percutaneous Endoscopic Gastrostomy Increases Survival in ALS: Twenty Years in Review
Laurie E Sterling MS1, Emily K Plowman PhD2, Charles Dion MS2, Ericka P Simpson MD1, Stanley H Appel MD1
1: Houston Methodist Neurological Institute, Houston, TX
2: Neuromotor Speech and Swallowing Restoration Laboratory, University of South Florida
INTRODUCTION
Percutaneous Endoscopic Gastrostomy (PEG) placement is utilized to maintain nutrition in individuals with ALS.
Current practice guidelines recommend PEG placement once baseline weight has dropped below 10% or prior to forced vital capacity (FVC) falling below 50%, however recent evidence suggests that PEG placement outcomes do not differ across FVC levels.
To date, only a few studies have examined the impact of PEG placement in relatively small numbers of ALS patients, therefore the specific impact of this intervention on survival remains unclear.
AIMS
Determine the impact of PEG placement on survival in ALS patients.
Examine the difference in survival after PEG placement between bulbar onset and spinal onset patients
METHODS
A retrospective chart review was performed on consecutive patients attending a multidisciplinary ALS clinic (Houston Methodist) between was performed.
Extracted data included: age, gender disease-onset type, PEG status (yes/no), date of PEG and time to death.
Kaplan-Meier survival curves, Wilcoxon logrank tests and Cox proportional hazard modeling performed to determine the impact of PEG placement on survival.
METHODS
Patient Demographics
A total of 2213 individuals with ALS were seen between and 2013.
Mean age was 59.6 (SD 12.8) and 58.9% male / 41.1% female.
74.9% demonstrated a spinal onset, 25.1% a bulbar onset
533 (24.3%) underwent PEG placement while 1659 (75.7%) did not undergo PEG placement.
Impact of PEG Placement of Survival
Overall, PEG tube placement significantly increased survival time by days.
In ALS patients with a spinal onset disease type, PEG placement increased survival by days (p<.001), however decreased survival time by 58 days in bulbar onset patients (p>0.05).
Table 1. Mean Survival (days) from symptom onset was significantly greater in spinal onset ALS patients.
The presence of a feeding tube was protective [RR:0.86, 95% CI: , X2(1)=5.97,p=.02] adjusting for age, gender and onset type. A relative risk of 0.86 indicates that the risk of death in the group with a feeding tube was 0.86 times the risk of death for the group without. This represents a 14% decrease in the risk of dying.
CONCLUSIONS
In this retrospective review, feeding tube placement was protective and favorably impacted survival in spinal- onset patients.
Given the lack of effective treatment interventions in ALS, these data highlight the important role of PEG placement in the ALS management.
PEG
NO PEG
Mean Diff
Chi Square
Bulbar:
-57.30
X2=1.04, p>0.05
Spinal:
X2=16.40, p<0.001
Overall:
1454.4
1346.9
+107.4*
X2=6.32, p<0.02