A retrospective study of percutaneous endoscopic gastrostomy in ALS patients during the BDNF and CNTF trials

• Published in: Journal of the neurological sciences Vol. 169; no. 1; pp. 118 - 125
• Main Authors: Kasarskis, Edward J., Scarlata, Debra, Hill, Robert, Fuller, Cynthia, Stambler, Nancy, Cedarbaum, Jesse M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Shannon Elsevier B.V 31.10.1999; Elsevier Science
• Subjects: Adult; Aged; Amyotrophic Lateral Sclerosis; Analysis of Variance; Biological and medical sciences; Brain-Derived Neurotrophic Factor - therapeutic use; Ciliary Neurotrophic Factor - therapeutic use; Endoscopy, Gastrointestinal; Female; Gastrostomy - methods; Humans; Male; Medical sciences; Middle Aged; Nutrition Assessment; Percutaneous endoscopic gastrostomy; Retrospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Percutaneous endoscopic gastrostomy; Amyotrophic lateral sclerosis; Gastrostomy; Human; Endoscopic surgery; Stomach; Nervous system diseases; Prognosis; Enteral administration; Feeding; Percutaneous route; Treatment; Central nervous system disease; Risk factor; Evolution; Degenerative disease; Timing; Predictive factor; Spinal cord disease; Food supplement
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/S0022-510X(99)00230-0

Percutaneous endoscopic gastrostomy (PEG) provides a reliable route for nutrition and hydration in ALS patients with dysphagia. We performed a retrospective analysis of the CNTF and BDNF databases to determine the clinical status of ALS patients within 30 days preceding PEG insertion. This analysis revealed an approximately 50% reduction of function across multiple measures of ALS disease status. A trend to earlier intervention with PEG was apparent upon review of published studies and the CNTF and BDNF studies. By comparing the rate of decline pre- and post-PEG, nutritional supplementation via PEG stabilized the weight loss experienced by patients. Death within 30 days post-PEG was associated with a marked reduction in forced vital capacity (FVC) and identified a group of ALS patients in whom PEG should be cautiously performed. These data emphasize the importance of sequential measurement of FVC in managing ALS patients to guide the timing of nutritional intervention with PEG.