Predictive factors for prognosis following unsedated percutaneous endoscopic gastrostomy in ALS patients

Bokuda, Kota; Shimizu, Toshio; Imamura, Kazuhiro; Kawata, Akihiro; Watabe, Kazuhiko; Hayashi, Masaharu; Nakayama, Yuki; Isozaki, Eiji; Nakano, Imaharu

doi:10.1002/mus.25051

Cited by 22 publications

(26 citation statements)

References 28 publications

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“…In the subgroup analysis, we found that the spinal-onset patients had a longer median duration in Stage 1 compared to the bulbar-onset patients. A previous study showed that the time from the symptom onset to PEG was shorter in the bulbar-onset group than that in the spinal-onset group ( 33 ). Similarly, another study demonstrated that the time from the onset to NIPPV was shorter in the bulbar-onset group compared to the spinal- and flail-limb groups ( 34 ).…”

Section: Discussionmentioning

confidence: 93%

Clinical Staging of Amyotrophic Lateral Sclerosis in Chinese Patients

et al. 2018

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Objective: It is important to explore the utility of clinical staging systems in the management of amyotrophic lateral sclerosis (ALS). Our aim was to assess the validity of King's College in a Chinese ALS cohort, by evaluating the duration and informativeness of each stage and examining the association between stage and prognosis.Methods: From May 2008 to December 2016, patients with a likely diagnosis of ALS were registered. We prospectively assessed the progression of the patients through the stages and calculated the duration of each stage.Results: The median duration in Stage 1 was 12.00 months, Stage 2 7.50 months, Stage 3 6.50 months, and Stage 4 4.10 months. Subset analysis revealed that the spinal-onset and early-onset patients had a longer median time in Stage 1 compared to bulbar-onset and late-onset patients, respectively. Riluzole treatment extended the durations of Stages 1 and 2, and the effect was maintained in patients with long-term use of riluzole (>6 months). Patients who initiated long-term riluzole therapy early, in Stage 1 or 2, had a longer Stage 2. Patients who received percutaneous gastrostomy endoscopy (PEG) or non-invasive positive-pressure ventilation (NIPPV) showed longer durations of Stage 4. The differences in survival time measured from each stage to death or censor date were significant.Conclusions: We validated the King's College staging system in a Chinese population, and showed this system to be useful in clinical practice. Patients with bulbar-onset or an age of onset>45 years tended to have rapidly progressing ALS. Riluzole may be more effective when initiated in an early disease stage and continued long-term. PEG and NIPPV treatments can extend disease duration of Stage 4.

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Section: Discussionmentioning

confidence: 93%

Clinical Staging of Amyotrophic Lateral Sclerosis in Chinese Patients

et al. 2018

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“…Although this criterion is very simple and useful in clinical practice, the FVC varies greatly under different conditions, and can show little to no decline until 12 months before death . Furthermore, there have been reports that gastric tube placement can be performed safely even in the later stages of the disease in individuals with a relatively low FVC . To define the appropriate timing of intervention in ALS, the decline rates of functional parameters are more important than the values evaluated at a single time‐point.…”

Section: Discussionmentioning

confidence: 99%

Cough peak flow decline rate predicts survival in patients with amyotrophic lateral sclerosis

et al. 2018

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“…Therefore, it is recommended to perform the procedure when the predicted FVC value is still > 50% [25,29,30]. Although a lower FVC is not a contraindication for PEG/RIG, the procedure should be performed with caution [25,29]. For a summary of indications for gastrostomy tube feeding, see Table 1.…”

Section: Indication and Methodsmentioning

confidence: 99%

“…Multiple studies have investigated an association between the FVC% at the time of PEG insertion and the post-PEG survival time. The implementation of PEG results in a longer survival in ALS patients as long as the FVC exceeds 38% of the predicted value [29]. Most studies have reported a significantly longer survival in patients with FVC > 50% compared to FVC < 50% of the predicted value [28,30,55].…”

Section: Effect Of Peg On Weight and Survivalmentioning

confidence: 99%

“…Determinants of a poor late outcome of PEG include an initial weight loss of over 10%, a decreased predicted value of FVC (< 50-70%), BMI (< 18kg/m 2 ), long-lasting swallowing difficulties prior to the start of PEG, older age, a low bulbar score of ALSFRS-R (≤ 5), and concomitant neurobehavioural dysfunction [19,28,29,30,42,43,47,54,[56][57][58][59]. Studies on the effect of gender have proved inconclusive [29,42,60].…”

Section: Effect Of Peg On Weight and Survivalmentioning

confidence: 99%

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Gastrostomy and mechanical ventilation in amyotrophic lateral sclerosis: how best to support the decision-making process?

Barć

Kuźma‐Kozakiewicz

2020

Neurol Neurochir Pol.

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The unfavourable outcome of amyotrophic lateral sclerosis (ALS) confronts patients with challenging decisions regarding life-sustaining measures. The decision-making process is usually triggered by medical consultations and patient-dependent factors. This may largely depend on the physician's depth of knowledge and professional experience. This paper presents an overview of the life-sustaining methods used in ALS and their effects on disease progression, survival and quality of life of patients and their caregivers. It is intended to aid physicians in their discussions with patients. We interrogate all the positive and negative facets of life-sustaining measures that may allow for optimisation of the decision-making process and care provision.

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Predictive factors for prognosis following unsedated percutaneous endoscopic gastrostomy in ALS patients

Abstract: PEG tube placement in ALS is recommended when FVC is ≥ 38% of predicted and when PaCO2 is normal. Muscle Nerve 54: 277-283, 2016.

Cited by 22 publications

References 28 publications

Clinical Staging of Amyotrophic Lateral Sclerosis in Chinese Patients

Clinical Staging of Amyotrophic Lateral Sclerosis in Chinese Patients

Cough peak flow decline rate predicts survival in patients with amyotrophic lateral sclerosis

Gastrostomy and mechanical ventilation in amyotrophic lateral sclerosis: how best to support the decision-making process?

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