Therapeutic effects of percutaneous endoscopic gastrostomy on survival in patients with amyotrophic lateral sclerosis: A meta-analysis

Abstract

Percutaneous endoscopic gastrostomy (PEG) is a method widely used for patients with amyotrophic lateral sclerosis (ALS); nevertheless, its effect on survival remains unclear. The purpose of this meta-analysis study was to determine the effects of PEG on survival in ALS patients. Relevant studies were retrieved from PubMed, EmBase, and the Cochrane Library databases, from inception to June 2017. Studies comparing PEG with other procedures in ALS patients were included. Odds ratios (ORs) in a random-effects model were used to assess the survival at different follow-up periods. Briefly, ten studies involving a total of 996 ALS patients were included. Summary ORs indicated that PEG administration was not associated with 30-day (OR = 1.59; 95%CI 0.93–2.71; P = 0.092), 10-month (OR = 1.25; 95%CI 0.72–2.17; P = 0.436), and 30-month (OR = 1.28; 95% CI 0.77–2.11; P = 0.338) survival rates, while they showed a beneficial effect in 20-month survival rate (OR = 1.97; 95%CI 1.21–3.21; P = 0.007). The survival rate was significantly prominent in reports published before 2005, and in studies with a retrospective design, sample size <100, mean age <60.0 years, and percentage male ≥50.0%. To sum up, these findings suggested that ALS patients administered with PEG had an increased 20-month survival rates, while there was no significant effect in 30-day, 10-month, and 30-month survival rates.

Endoscopic management of enteral tubes in adult patients – Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…A recent European survey of 244 patients showed that EN support through a percutaneous gastrostomy was used in 6 % -23 % [66]. Even though there has been no RCT comparing EN to oral feeding in ALS patients in terms of survival, nutritional status, and QOL, two meta-analyses of 3 [67] and 10 cohort studies [68], respectively, showed a moderate survival advantage for patients with ALS on percutaneous gastrostomy EN support. The most recent analysis specifically showed a beneficial effect in 20-month survival rate (odds ratio [OR] 1.97, 95 %CI 1.21 -3.21; P = 0.007], but no significant effect on 30-day, 10month, and 30-month survival rates [68].…”

A Comprehensive Examination of Percutaneous Endoscopic Gastrostomy and Its Association with Amyotrophic Lateral Sclerosis Patient Outcomes

“…PEG typically delivers 30% of the patients’ daily caloric intake [6]. Prevention of rapid weight decline [7] and having a higher pre-morbid body mass index (BMI) [8,9] is thought to positively contribute to survival [10,11]. Naturally, a physician’s choice to prescribe PEG and a patient’s choice to accept it must take into account the heterogeneity of ALS, symptoms most troubling to each individual patient, the patient’s age of onset, and the patient’s personal preferences about surgery and supplementary nutrition.…”

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

“…One study reported an even shorter survival time in the PEG group, but the control group consisted of individuals who declined the use of PEG as well as some who had no indication for parenteral feeding [28]. In a meta-analysis (n = 966) using an odds ratio (OD) as the survival rate, a higher mortality in patients without PEG compared to the PEG group was found only at the 20-month follow-up (OR = 1.97; 95% CI 1.21-3.21, p = 0.007); there was no significant difference in the 30-day or 30-month rates [61].…”