High success, low 30-day mortality and prolonged survival following PEG insertion in motor neurone disease patients undergoing multidisciplinary clinic review.

Introduction Enteral feeding is used to support patients with motor neurone disease (MND). The appropriateness of tube insertion and optimum timing is a challenge in this complex group of patients. We provide a multidisciplinary nutrition clinic to assess patients and arrange for PEG placement if appropriate. PEG tubes are placed by two consultant endoscopists with a combination of local anaesthetic (LA) spray and fentanyl. Methods We retrospectively reviewed the records of all MND patients referred for consideration of PEG placement between January 2019 and October 2022. Patients' age of symptom onset, symptom location onset, pre-procedural weight loss, respiratory function test, PEG insertion method and complications were reviewed. Kaplan-Meier survival graphs were generated with censored log rank tests. Patients who were alive by the time of analysis (Dec 2022) were censored. Log rank tests were conducted by comparing patients' pre-procedural weight, MND onset site and pre-procedural respiratory compromise. Results 48 MND patients were reviewed in the multidisciplinary clinic. 22 did not go forward for PEG insertion. 26 patients had attempted PEG insertion. Two had failed procedures - one for anatomical reasons and one desaturated prior to the procedure. These two patients were removed from the survival analysis. 25 out of the 26 procedures were completed with LA spray and fentanyl only with one patient requiring midazolam. The age range of the patients was 42-82 with a median of 63. BMI ranged from 16.9 to 34 with a median of 23.1. 13 had >10% body weight pre-procedural weight loss and 13 did not. 24/26 patients had documented respiratory function tests. 10 did not have compromised respiratory functions and 14 did. MND onset classification at presentation was as follows: bulbar only (nine), limb + bulbar (three), limb only (12), respiratory only (one), neck only (one). Range of survival post PEG was 44-985 days, a mean of 263.5 days and median 168 days. None died within 30 days of PEG insertion. Only location onset of symptoms had statistically significant impact on survival duration. Fig 1 shows the Kaplan-Meier survival curve. Conclusions Our MDT approach is effective at selecting a group of patients who are likely to benefit from PEG insertion. It is likely that there was no relationship with weight loss and respiratory function as the patients most likely to have been affected by this did not go forward for tube insertion. Our sample size is small. PEG insertion by two senior endoscopists is safe and well tolerated with LA and fentanyl only avoiding the need for general anaesthetic or sedation, which is high-risk in this patient group. [ABSTRACT FROM AUTHOR]