Successive application of percutaneous endoscopic gastrostomy with jejunal extension and percutaneous endoscopic jejunostomy in a case of multiple system atrophy

Ogawa, Takumi; Oodaira, Hironori; Suzuki, Yutaka; Hashimoto, Ritsuo; Kato, Hiroyuki

doi:10.5692/clinicalneurol.49.370

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…Finally, in cases of severe dysphagia and esophageal dysmotility, alternative nutritional support can be provided. For instance, in a patient with MSA who had experienced recurrent aspiration pneumonia while receiving PEG nutrition due to gastroesophageal reflux, a jejunal extension to PEG was applied; then, following subsequent jejunal tube occlusion, a percutaneous endoscopic jejunostomy was placed for nutrition [57].…”

Section: Treatment Of Dysphagiamentioning

confidence: 99%

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Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment

Calandra‐Buonaura

Alfonsi

Vignatelli

et al. 2021

Parkinsonism & Related Disorders

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Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure plus cerebellar syndrome and/or parkinsonism. Dysphagia is a frequent and disabling symptom in MSA and its occurrence within 5 years of motor onset is an additional diagnostic feature. Dysphagia can lead to aspiration pneumonia, a recognized cause of death in MSA. Guidelines for diagnosis and management of dysphagia in MSA are lacking. An International Consensus Conference among experts with methodological support was convened in Bologna to reach consensus statements for the diagnosis, prognosis, and treatment of dysphagia in MSA. Abnormalities of the oral and pharyngeal phases of swallowing, esophageal dysfunction and aspiration occur in MSA and worsen as the disease progresses. According to the consensus, dysphagia should be investigated through available screening questionnaires and clinical and instrumental assessment (videofluoroscopic study or fiberoptic endoscopic evaluation of swallowing and manometry) at the time of MSA diagnosis and periodically thereafter. There is evidence that dysphagia is associated with poor survival in MSA, however effective treatments for dysphagia are lacking. Compensatory strategies like diet modification, swallowing maneuvers and head postures should be applied and botulinum toxin injection may be effective in specific conditions. Percutaneous endoscopic gastrostomy may be performed when there is a severe risk of malnutrition and pulmonary complications, but its impact on survival is undetermined. Several research gaps and unmet needs for research involving diagnosis, prognosis, and treatment were identified.

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Section: Treatment Of Dysphagiamentioning

confidence: 99%

“…The following statements are based on core literature consisting of Class IV level studies (Table 3) and expert adaptation of knowledge from the literature on dysphagia, selected on the basis of the analogy principle [2,35,49,54,56,57].…”

Section: Statements On Dysphagia Treatmentmentioning

confidence: 99%

Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment

Calandra‐Buonaura

Alfonsi

Vignatelli

et al. 2021

Parkinsonism & Related Disorders

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A novel ballooned-tip percutaneous endoscopic gastrojejunostomy tube: a pilot study

Kim

Victor

Stein

et al. 2013

Gastrointestinal Endoscopy

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Esophageal Dysmotility in Multiple System Atrophy: A Retrospective Cross-Sectional Study

Ueha,

Koyama,

Seto

et al. 2024

JCM

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Background/Objective: Multiple system atrophy (MSA) is often associated with dysphagia and esophageal dysmotility (ED). However, ED in patients with MSA is poorly understood. To assess the relationship between ED, dysphagia, and other clinical findings in such patients and investigate the details of ED in MSA using high-resolution manometry (HRM). Methods: Patients from The University of Tokyo Hospital with MSA who underwent swallowing examinations, esophagography, and HRM between 2017 and 2022 were enrolled. A retrospective chart review of patients’ backgrounds, swallowing function, and esophageal motility was performed. ED was evaluated using the Chicago Classification version 4.0. Results: Seventy-four patients with MSA were identified. The median age was 64 years, 48 patients (65%) were male, and the cerebellar variant type was predominant (69%). Abnormal upper esophageal sphincter (UES) resting pressure was observed in 34 patients (46%) and intraesophageal stasis in 65 (88%). High-severity MSA was a risk factor for developing dysphagia, vocal fold movement impairment, and abnormal UES function (p < 0.05). However, no overt clinical risk factors for ED were identified. Various types of ED were detected using HRM, and ineffective esophageal motility was the most frequent disorder. Conclusions: ED is a common occurrence in patients with MSA. Although a high-severity MSA may be a risk factor for developing dysphagia and vocal fold motion impairment, ED can occur regardless of clinical severity. Since ED is rarely detected based on subjective symptoms, careful evaluation of esophageal motility by esophagography or HRM is warranted in patients with MSA.

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Successive application of percutaneous endoscopic gastrostomy with jejunal extension and percutaneous endoscopic jejunostomy in a case of multiple system atrophy

Cited by 4 publications

References 9 publications

Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment

Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment

A novel ballooned-tip percutaneous endoscopic gastrojejunostomy tube: a pilot study

Esophageal Dysmotility in Multiple System Atrophy: A Retrospective Cross-Sectional Study

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