4741 Outcome after Percutaneous Endoscopic Gastrostomy in Patients with Bulbar and Spinal Amyotrophic Lateral Sclerosis.

Backgroundand aim: Dysphagia occurs in the last phase of the course of ASL and is associated with an adverse prognosis. PEG has been proposed as symptomatic treatment of dysphagia in patients with both bulbar and spinal ASL. The aim of our study was to evaluate the effects of PEG placement and to describe long-term nutritional status and survival of ASL patients. Methods: Since January 1993, 49 patients (19M/30F), mean age 61.7 years (range 33-77) with bulbar (25) and spinal (24) ASL were enrolled in the study and underwent PEG after a median time of 163 from dysphagia onset. Forced Vital Capacity (FVC), Norris scale, weight loss (WL), body mass index (BMI), serum prealbumin, albumin, trasnferrin, daily energy and protein intake were evaluated every two months in the follow-up period. Results: PEG was successfully placed in all patients. Three patients received a 9 Fr enteral tube, 38 a 14 Fr and 8 a 20 Fr.There were no procedure-related complications or 30-day mortality. The median body weight improved from 54.4+Kg at the time of PEG to 62.5+.8 Kg at six months follow-up. The median survival after PEG was 185 days (range 31-1080 days). Death was always related to respiratory failure. In univariate analysis factors influencing the survival after PEG were WL% (WL>10% median survival 116 days, WL<10% median survival 305 days, p=0.008) and FVC% (FVC<65% median survival 138 days, FVC>65% median survival 241 days, p=0.04). No statistically significant differences were observed in terms of survival in patients with bulbar and spinal ASL. In patients in whom PEG was placed within six months from the onset of dysphagia there was a trend toward a longer survival in comparison with patients who had PEG six months later than the onset of dysphagia. Conclusions: PEG represents a safe and effective method for the management of ASL patients who develop dysphagia. WL >10% and FVC<65% at the time of PEG are related to a worse prognosis. No differences in survival were recorded between bulbar and spinal ASL. Early placement of PEG could improve survival in ASL patients who develop dysphagia. Backgroundand aim: Dysphagia occurs in the last phase of the course of ASL and is associated with an adverse prognosis. PEG has been proposed as symptomatic treatment of dysphagia in patients with both bulbar and spinal ASL. The aim of our study was to evaluate the effects of PEG placement and to describe long-term nutritional status and survival of ASL patients. Methods: Since January 1993, 49 patients (19M/30F), mean age 61.7 years (range 33-77) with bulbar (25) and spinal (24) ASL were enrolled in the study and underwent PEG after a median time of 163 from dysphagia onset. Forced Vital Capacity (FVC), Norris scale, weight loss (WL), body mass index (BMI), serum prealbumin, albumin, trasnferrin, daily energy and protein intake were evaluated every two months in the follow-up period. Results: PEG was successfully placed in all patients. Three patients received a 9 Fr enteral tube, 38 a 14 Fr and 8 a 20 Fr.There were no procedure-related complications or 30-day mortality. The median body weight improved from 54.4+Kg at the time of PEG to 62.5+.8 Kg at six months follow-up. The median survival after PEG was 185 days (range 31-1080 days). Death was always related to respiratory failure. In univariate analysis factors influencing the survival after PEG were WL% (WL>10% median survival 116 days, WL<10% median survival 305 days, p=0.008) and FVC% (FVC<65% median survival 138 days, FVC>65% median survival 241 days, p=0.04). No statistically significant differences were observed in terms of survival in patients with bulbar and spinal ASL. In patients in whom PEG was placed within six months from the onset of dysphagia there was a trend toward a longer survival in comparison with patients who had PEG six months later than the onset of dysphagia. Conclusions: PEG represents a safe and effective method for the management of ASL patients who develop dysphagia. WL >10% and FVC<65% at the time of PEG are related to a worse prognosis. No differences in survival were recorded between bulbar and spinal ASL. Early placement of PEG could improve survival in ASL patients who develop dysphagia.