Timing and impact of percutaneous endoscopic gastrostomy insertion in patients with amyotrophic lateral sclerosis: a comprehensive analysis

Dysphagia is common in amyotrophic lateral sclerosis (ALS) patients, often requiring percutaneous endoscopic gastrostomy (PEG) for enteral nutrition. We retrospectively analyzed data from 188 Korean patients with ALS who underwent PEG tube insertion at five-time points: symptom onset (t 1 ), diagnos...

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Bibliographic Details
Published in:Scientific reports 2024-03, Vol.14 (1), p.7103-7103, Article 7103
Main Authors: Son, Bugyeong, Lee, Jisu, Ryu, Soorack, Park, Yongsoon, Kim, Seung Hyun
Format: Article
Language:English
Subjects:
692/617/375/1917
692/700
692/700/2814
Amyotrophic lateral sclerosis
Diagnosis
Dysphagia
Endoscopy
Enteral nutrition
Humanities and Social Sciences
multidisciplinary
Ostomy
Science
Science (multidisciplinary)
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Summary:Dysphagia is common in amyotrophic lateral sclerosis (ALS) patients, often requiring percutaneous endoscopic gastrostomy (PEG) for enteral nutrition. We retrospectively analyzed data from 188 Korean patients with ALS who underwent PEG tube insertion at five-time points: symptom onset (t 1 ), diagnosis (t 2 ), recommended time for gastrostomy (t 3 ), PEG insertion (t 4 ), and one-year post-insertion (t 5 ). The recommended time point for gastrostomy (T -rec for gastrostomy) was defined as the earlier time point between a weight loss of more than 10% and advanced dysphagia indicated by the ALSFRS-R swallowing subscore of 2 or less. The T -rec for gastrostomy was reached at 22 months after symptom onset, followed by PEG insertion at 30 months, resulting in an 8-month delay. During the delay, the ALSFRS-R declined most rapidly at 1.7 points/month, compared to 0.8 points/month from symptom onset to diagnosis, 0.7 points/month from diagnosis to T -rec for gastrostomy, and 0.6 points/month after the PEG insertion. It is crucial to discuss PEG insertion before significant weight loss or severe dysphagia occurs and minimize the delay between the recommended time for gastrostomy and the actual PEG insertion. A stratified and individualized multidisciplinary team approach with careful symptom monitoring and proactive management plans, including early PEG insertion, should be prioritized to improve patient outcomes.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-024-56752-5