TY - JOUR
T1 - Percutaneous endoscopic gastrostomy (PEG) in patients with ALS and bulbar dysfunction
AU - Mitsumoto, Hiroshi
AU - Davidson, M.
AU - Moore, D.
AU - Gad, N.
AU - Brandis, M.
AU - Ringel, S.
AU - Rosenfeld, J.
AU - Shefner, J. M.
AU - Strong, M. J.
AU - Anderson, F. A.
AU - Echols, Carol
AU - Heiman-Patterson, Terry
AU - Paylor, Theresa
AU - Huffnagles, Vera
AU - Murphy, Julie
AU - Lou, Jau Shin
AU - Tullar, David
AU - McClusky, Leo
AU - Damiano, Pat
AU - Miller, Robert
AU - Tkachenko, Igor
AU - Neville, Hans
AU - Blackwell, Kristin Howell
AU - Oh, Shin
AU - Olney, Richard
AU - Mass, Jason
AU - Pascuzzi, Robert
AU - Michaels, Angi
AU - Pioro, Erik
AU - Andrews-Hinders, Doreen
AU - Rosenfeld, Jeffrey
AU - King, Ruth
AU - Scelsa, Stephen
AU - Shefner, Jeremy
AU - Lepsky, Tina
AU - Strong, Michael
AU - Rowe, Ann
AU - Sufit, Robert L.
AU - Casey, Patricia
N1 - Funding Information:
1Eleanor and Lou Gehrig MDA/ALS Research Center, The Neurological Institute, Columbia University, New York, 2University of Massachusetts, Worcester, 3California Pacific Medical Center, San Francisco, 4University of Colorado, Denver, 5Carolinas Medical Center, Charlotte, 6State University of New York, Syracuse, 7University of Western Ontario, London, Canada and 8Northwestern University, Chicago USA Correspondence: Dr. Hiroshi Mitsumoto, The Eleanor and Lou Gehrig MDA/ALS Research Center, The Neurological Institute, Columbia Presbyterian Medical Center, 710 West 168th St, New York, NY 10032, USA Tel: 212 305 2940 Fax: 212 305 2750 E-mail: [email protected] The ALS Patient Care Database is supported by an unrestricted educational grant from Aventis Pharmaceuticals, by a grant from The ALS Association, and endorsed by the World Federation of Neurology Motor Neuron Disease Committee.
PY - 2003/9
Y1 - 2003/9
N2 - Objective: To compare characteristics of ALS patients with and without percutaneous endoscopic gastrostomy (PEG). Methods: Using the ALS Patient Care Database, data from patients with and without PEG with ALS Functional Rating Scale-bulbar subscale (ALSFRSb) scores ≤5 were analyzed; follow-up data were also collected. Results: PEG use was markedly increased with declining ALSFRSb scores. Demographics did not differ, but ALSFRS composite scores and bulbar and arm subscale scores were lower (P<0.0001). PEG patients used significantly more assistive devices, multidisciplinary care, home care nurses and aides, had more frequent physician and emergency department visits and hospital admissions (P<0.0001), and had lower health status based on the mini-SIP scale (P=0.0047). PEG use varied greatly between ALS centers. In the follow-up study, positive impact of PEG was noted in 79% of PEG patients but in only 37.5% of patients who received PEG later, based on a small number of patients. PEG use showed no survival benefit. Conclusion: Patients did not receive PEG until bulbar function was severely reduced and overall ALS had markedly progressed. PEG may have been performed too late to demonstrate survival benefits. Aggressive proactive nutritional management appears essential in patients with ALS. To determine whether PEG provides benefits, it must be performed at earlier stages of the disease and prospectively studied.
AB - Objective: To compare characteristics of ALS patients with and without percutaneous endoscopic gastrostomy (PEG). Methods: Using the ALS Patient Care Database, data from patients with and without PEG with ALS Functional Rating Scale-bulbar subscale (ALSFRSb) scores ≤5 were analyzed; follow-up data were also collected. Results: PEG use was markedly increased with declining ALSFRSb scores. Demographics did not differ, but ALSFRS composite scores and bulbar and arm subscale scores were lower (P<0.0001). PEG patients used significantly more assistive devices, multidisciplinary care, home care nurses and aides, had more frequent physician and emergency department visits and hospital admissions (P<0.0001), and had lower health status based on the mini-SIP scale (P=0.0047). PEG use varied greatly between ALS centers. In the follow-up study, positive impact of PEG was noted in 79% of PEG patients but in only 37.5% of patients who received PEG later, based on a small number of patients. PEG use showed no survival benefit. Conclusion: Patients did not receive PEG until bulbar function was severely reduced and overall ALS had markedly progressed. PEG may have been performed too late to demonstrate survival benefits. Aggressive proactive nutritional management appears essential in patients with ALS. To determine whether PEG provides benefits, it must be performed at earlier stages of the disease and prospectively studied.
KW - Amyotrophic lateral sclerosis
KW - Enteral feeding
KW - Motor neuron disease
KW - Nutritional care
KW - Percutaneous endoscopic gastrostomy
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U2 - 10.1080/14660820310011728
DO - 10.1080/14660820310011728
M3 - Article
C2 - 13129795
AN - SCOPUS:0141614836
SN - 1466-0822
VL - 4
SP - 177
EP - 185
JO - Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders
JF - Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders
IS - 3
ER -