Frequency, timing and outcome of gastrostomy tubes for amyotrophic lateral sclerosis/motor neurone disease--a record linkage study from the Scottish Motor Neurone Disease Register.
OBJECTIVE
To describe the frequency, timing and outcome from gastrostomy in amyotrophic lateral sclerosis/motor neurone disease (ALS/MND).


METHODS
The Scottish MND Register, a population based disease register (1989-1998), with record linkage to the Scottish Morbidity 1 dataset of hospital discharges coded for gastrostomy procedure was used. Descriptive statistics of patients undergoing gastrostomy were extracted. Survival analysis used Kaplan Meier and Cox proportional hazards methods.


RESULTS
For patients diagnosed between 1989-98, 142 percutaneous endoscopic gastrostomy (PEG) insertion episodes were identified in 1226 patients, 130 of which occurred before the censoring date of 31 December 1999.Annually, on average, 5% of all revalent patients underwent gastrostomy, and this rate appeared to double between 1989-98. The cumulative incidence of gastrostomy was 11%. Mean age at PEG tube insertion was 66.8 years, with a mean disease duration of 24 months. Median survival from PEG tube insertion was 146 days. The 1 month mortality after gastrostomy was 25%. Gastrostomy did not confer a survival advantage compared with no gastrostomy.


CONCLUSIONS
We found that gastrostomy feeding tubes are being inserted more frequently in people with ALS/MND. An unexpectedly high early mortality was detected which probably reflects a lack of selection bias compared with previously published data. It is possible that changes in the practice of gastrostomy placement since 1998 result in better outcomes for patients with ALS/MND. Prospective studies are required to assess the risks and benefits of enteral nutrition in ALS/MND.
Forbes
Raeburn B
RB
Department of Neurology, Royal Victoria Hospital, Grosvenor Rd, Belfast, Northern Ireland BT12 6BA, UK. Raeburnforbes@aol.com
Colville
Shuna
S
Swingler
Robert J
RJ
D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000401:mortality; D001933:Brain Stem / Q000503:physiopathology; D003680:Deglutition Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004750:Enteral Nutrition / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D019782:Riluzole / Q000627:therapeutic use; D012606:Scotland; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D019782:Riluzole