Clin Endosc.  2017 May;50(3):270-278. 10.5946/ce.2016.106.

Percutaneous Endoscopic Gastrostomy Tube Insertion in Neurodegenerative Disease: A Retrospective Study and Literature Review

• Sarkar P
• Cole A
• Scolding N
• Rice CM

• KMID: 2388824
• DOI: http://doi.org/10.5946/ce.2016.106

Abstract

BACKGROUND/AIMS
With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome.
METHODS
A retrospective case note review of patients referred for PEG insertion by neurologists in a single neuroscience center was conducted according to a pre-determined set of standards. For the literature review, we identified references from searches of PubMed, mainly with the search items "percutaneous endoscopic gastrostomy" and "neurology" or "neurodegenerative disease."
RESULTS
Short-term mortality and morbidity associated with PEG in patients with neurological disease were significant. Age greater than 75 years was associated with poor outcome, and a trend toward adverse outcome was observed in patients with low serum albumin.
CONCLUSIONS
This study highlights the relatively high risk of PEG in patients with neurodegenerative disease. We present points for consideration to improve outcome in this particularly vulnerable group of patients.

Keyword

Percutaneous endoscopic gastrostomy; Neurodegenerative diseases; Multiple sclerosis; Parkinson disease; Motor neuron disease

MeSH Terms

Dementia
Gastrostomy*
Humans
Mortality
Motor Neuron Disease
Multiple Sclerosis
Neurodegenerative Diseases*
Neurosciences
Parkinson Disease
Retrospective Studies*
Serum Albumin
Stroke
Serum Albumin

Reference

1. Ponsky JL, Gauderer MW. Percutaneous endoscopic gastrostomy: indications, limitations, techniques, and results. World J Surg. 1989; 13:165–170.

2. Löser C, Wolters S, Fölsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients: a four-year prospective study. Dig Dis Sci. 1998; 43:2549–2557.

3. Löser C, Aschl G, Hébuterne X, et al. ESPEN guidelines on artificial enteral nutrition: percutaneous endoscopic gastrostomy (PEG). Clin Nutr. 2005; 24:848–861.

4. Mazzini L, Corrà T, Zaccala M, Mora G, Del Piano M, Galante M. Percutaneous endoscopic gastrostomy and enteral nutrition in amyotrophic lateral sclerosis. J Neurol. 1995; 242:695–698.

5. Hull MA, Rawlings J, Murray FE, et al. Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet. 1993; 341:869–872.

6. Löser C. Clinical aspects of long-term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). J Nutr Health Aging. 2000; 4:47–50.

7. Britton JE, Lipscomb G, Mohr PD, Rees WD, Young AC. The use of percutaneous endoscopic gastrostomy (PEG) feeding tubes in patients with neurological disease. J Neurol. 1997; 244:431–434.

8. Spataro R, Ficano L, Piccoli F, La Bella V. Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: effect on survival. J Neurol Sci. 2011; 304:44–48.

9. Luman W, Kwek KR, Loi KL, Chiam MA, Cheung WK, Ng HS. Percutaneous endoscopic gastrostomy: indications and outcome of our experience at the Singapore General Hospital. Singapore Med J. 2001; 42:460–465.

10. James A, Kapur K, Hawthorne AB. Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing. 1998; 27:671–676.

11. Burney RE, Bryner BS. Safety and long-term outcomes of percutaneous endoscopic gastrostomy in patients with head and neck cancer. Surg Endosc. 2015; 29:3685–3689.

12. Khokhar N, Gill ML. Percutaneous endoscopic gastrostomy: nine years experience in a tertiary care centre in Pakistan. J Pak Med Assoc. 2005; 55:108–110.

13. Sanders DS, Carter MJ, D’Silva J, James G, Bolton RP, Bardhan KD. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol. 2000; 95:1472–1475.

14. Chiò A, Finocchiaro E, Meineri P, Bottacchi E, Schiffer D. Safety and factors related to survival after percutaneous endoscopic gastrostomy in ALS. ALS Percutaneous Endoscopic Gastrostomy Study Group. Neurology. 1999; 53:1123–1125.

15. ProGas Study Group. Gastrostomy in patients with amyotrophic lateral sclerosis (ProGas): a prospective cohort study. Lancet Neurol. 2015; 14:702–709.

16. Arora G, Rockey D, Gupta S. High In-hospital mortality after percutaneous endoscopic gastrostomy: results of a nationwide population-based study. Clin Gastroenterol Hepatol. 2013; 11:1437–1444. e3.

17. Janes SE, Price CS, Khan S. Percutaneous endoscopic gastrostomy: 30-day mortality trends and risk factors. J Postgrad Med. 2005; 51:23–28.

18. Tominaga N, Shimoda R, Iwakiri R, et al. Low serum albumin level is risk factor for patients with percutaneous endoscopic gastrostomy. Intern Med. 2010; 49:2283–2288.

19. Czell D, Bauer M, Binek J, Schoch OD, Weber M. Outcomes of percutaneous endoscopic gastrostomy tube insertion in respiratory impaired amyotrophic lateral sclerosis patients under noninvasive ventilation. Respir Care. 2013; 58:838–844.

20. Allen JA, Chen R, Ajroud-Driss S, et al. Gastrostomy tube placement by endoscopy versus radiologic methods in patients with ALS: a retrospective study of complications and outcome. Amyotroph Lateral Scler Frontotemporal Degener. 2013; 14:308–314.

21. Rabeneck L, Wray NP, Petersen NJ. Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes. J Gen Intern Med. 1996; 11:287–293.

22. Leeds JS, McAlindon ME, Grant J, Robson HE, Lee FK, Sanders DS. Survival analysis after gastrostomy: a single-centre, observational study comparing radiological and endoscopic insertion. Eur J Gastroenterol Hepatol. 2010; 22:591–596.

23. Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J Gastroenterol Hepatol. 2000; 15:21–25.

24. Zalar AE, Guédon C, Piskorz EL, Sánchez Basso A, Ducrotté P. Percutaneous endoscopic gastrostomy in patients with neurological diseases. Results of a prospective multicenter and international study. Acta Gastroenterol Latinoam. 2004; 34:127–132.

25. Shimizu T, Hanaoka T, Hayashi H, Inoue H, Imamura K, Oyanagi K. Percutaneous endoscopic gastrostomy in patients with intractable neurological diseases--retrospective study of the indication, complication and prognosis. Rinsho Shinkeigaku. 2007; 47:565–570.

26. Rio A, Ellis C, Shaw C, et al. Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone disease. J Hum Nutr Diet. 2010; 23:408–415.

27. Forbes RB, Colville S, Swingler RJ; Scottish Motor Neurone Disease Research Group. Frequency, timing and outcome of gastrostomy tubes for amyotrophic lateral sclerosis/motor neurone disease: a record linkage study from the Scottish Motor Neurone Disease Register. J Neurol. 2004; 251:813–817.

28. Russ KB, Phillips MC, Wilcox CM, Peter S. Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis. Am J Med Sci. 2015; 350:95–97.

29. Cullinane M, Gray AJ, Hargraves CM, et al. The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death. London: NCEPOD;2004.

30. National Collaborating Centre for Acute Care (Great Britain); National Institute for Health and Clinical Excellence (Great Britain), et al. Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Institute for Health and Clinical Excellence;2006.

31. NHS National Patient Safety Agency, et al. Rapid response report NPSA/2010/RRR010: early detection of complications after gastrostomy [Internet]. Redditch: NHS; c2010 [cited 2016 Sep 19]. Available from: http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=73759&servicetype=Attachment&type=full.

32. Lucendo AJ, Friginal-Ruiz AB. Percutaneous endoscopic gastrostomy: an update on its indications, management, complications, and care. Rev Esp Enferm Dig. 2014; 106:529–539.

33. Poulsen M, Trezza M, Atimash GH, et al. Risk factors for morbidity and mortality following gastroenterostomy. J Gastrointest Surg. 2009; 13:1238–1244.

34. Onishi J, Kuzuya M, Sakaguchi H. Survival rate after percutaneous endoscopic gastrostomy in a long-term care hospital. Clin Nutr. 2004; 23:1248–1249.

35. Sarfaty M, Nefussy B, Gross D, Shapira Y, Vaisman N, Drory VE. Outcome of percutaneous endoscopic gastrostomy insertion in patients with amyotrophic lateral sclerosis in relation to respiratory dysfunction. Amyotroph Lateral Scler Frontotemporal Degener. 2013; 14:528–532.

36. Thornton FJ, Fotheringham T, Alexander M, Hardiman O, McGrath FP, Lee MJ. Amyotrophic lateral sclerosis: enteral nutrition provision: endoscopic or radiologic gastrostomy? Radiology. 2002; 224:713–717.

37. Chiò A, Galletti R, Finocchiaro C, et al. Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS. J Neurol Neurosurg Psychiatry. 2004; 75:645–647.

38. Shaw AS, Ampong MA, Rio A, et al. Survival of patients with ALS following institution of enteral feeding is related to pre-procedure oximetry: a retrospective review of 98 patients in a single centre. Amyotroph Lateral Scler. 2006; 7:16–21.

39. Chavada G, El-Nayal A, Lee F, et al. Evaluation of two different methods for per-oral gastrostomy tube placement in patients with motor neuron disease (MND): PIG versus PEG procedures. Amyotroph Lateral Scler. 2010; 11:531–536.