Introduction Motor neuron disease (MND) is a progressive neurodegenerative disease. For patients with dysphagia or weight loss, the decision to recommend enteral tube feeding is complex, and it remains controversial that gastrostomy insertion improves survival. This study evaluated the outcomes of patients with MND who underwent either percutaneous endoscopic gastrostomy (PEG) or radiologically-inserted gastrostomy (RIG) and in those who did not have a gastrostomy.
Method A retrospective review of 55 patients with MND referred for nutritional assessment between July 2012 and July 2015 was performed. Data was analysed for the following: timeframe from diagnosis of MND to referral, decision for gastrostomy, mode of insertion (PEG or RIG), complications and survival outcomes. complications and survival outcomes.
Results From 2012 to 2015, 55 patients (27 males, 28 females) with MND were referred for nutritional assessment. The mean age at diagnosis was 65.59 years while the mean time from diagnosis to referral was 13.12 months. The mean body mass index (BMI) was 23.4 kg/m2 and the mean percentage of weight loss at the time of assessment was 11.75%. 30.3% of the patients were on NIV at initial review.
49 patients (87.5%) were offered a gastrostomy. Of those, 45 had the procedure, 2 died before the procedure and 2 declined it. Of the six patients that were not offered gastrostomy, 2 had advanced disease while 4 were felt to have stable nutritional autonomy at time of review. 21 patients underwent PEG (46.7%) and 24 had a RIG (53.3%). 14 of the 16 patients (87%) on NIV underwent a RIG. 1 patient had an unsuccessful RIG insertion, and declined further intervention. 4 patients developed complications after insertion (3 had tube displacement with 2 of them developing intra-abdominal sepsis; 1 other patient died following intra-abdominal sepsis)
The 30 day mortality was 44.4% for those that did not get a gastrostomy compared to 13% for those that had a gastrostomy tube inserted. The 1 year mortality was 66.7% and 67% respectively.
Conclusion Compared to a previous study at the same centre,1 fewer patients are on NIV at the initial review (30.3% compared to 54% in 2011) and more PEGs are being offered (46.7% compared to 33.3% in 2011). This could reflect that patients with MND are being referred earlier in the course of their disease for nutritional assessment. Despite this, 1 year mortality was high whether or not patients had gastrostomy for nutritional support. Further studies should focus on pragmatic outcomes such as quality of life and carer burden.
. Gledhill T, Lekharaju V, Bliss P PWE-195 Outcomes of Nutritional Assessment and Gastrostomy in Patients with Motor Neurone Disease (MND): A 4 Year Experience Gut2013;62:A209–A210.
Disclosure of Interest None Declared
- enteral nutrition
- motor neurone disease