Introduction Percutaneous endoscopic gastrostomy (PEG) is recommended for motor neurone disease patients with dysphagia and accelerated weight loss. However PEG has been suggested as inadvisable in the past in patients with impaired respiratory function. Recent small studies have found satisfactory outcomes using non invasive ventilation (NIV) to assist PEG placement in this setting. We set up a service performing this technique for our region, and analysed our outcomes.
Methods 26 patients with motor neurone disease were included in the study from Nov 2011 – Oct 2013; 11 (42%) were external referrals. Patients had respiratory assessment prior to the procedure including sniff nasal pressures, arterial CO2 measurement, overnight oximetry and spirometry as directed by our respiratory physician. A modified oro-nasal mask with a endoscopic port was fitted prior to the procedure and NIV initiated and controlled by the respiratory physician. The PEG (Freka PEG, Bad Homburg, Germany) was inserted under continuous NIV which continued until the patient was fully awake in recovery. Prophylactic antibiotics were given routinely. Demographic and technical data, complications and survival were recorded.
Results Median age at time of PEG was 68 yrs (range 43–92), male 42%. Mean BMI was 22 (range 16–33). 3 patients (12%) were receiving NIV prior to referral. Mean dose of midazolam was 1.4 mg (range 0–3.5). 2 patients had local anaesthetic spray as an alternative.
PEG tube was successfully placed in 25 (96%) patients; in 1 the procedure had to be abandoned due to laryngospasm and hypoxia. Median observed follow up post-PEG insertion was 186 days (range 16–677). There was 1 death within 30 days of PEG placement, at day 16 due to pneumonia superimposed on type 2 respiratory failure. 19 patients died (73%) during follow up, all due to complications of the index disease, with median time to death 150 days (range 16–441). There were minor complications in 3 patients (12%) (2 PEG site infection treated successfully, 1 respiratory depression requiring flumazenil).
Conclusion PEG placement can be safely and effectively achieved in MND patients with impaired respiratory function using non invasive ventilatory support. This offers a viable alternative to radiological or surgical techniques in these patients. We advocate a referral service for this specialised multi-specialty approach.
Disclosure of Interest None Declared.
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