title: [Percutaneous endoscopic gastrostomy in a myotrophic lateral sclerosis. Experience in a district general hospital].
abstract: BACKGROUND
  Amyotrophic Lateral Sclerosis (ALS) is a degenerative disorder that affects the pyramidal tract, producing progressive motor dysfunctions leading to paralysis. These patients can present with dysphagia, requiring nutritional support with a nasogastric tube or Percutaneous Endoscopic Gastrostomy (PEG). PEG is associated with increased survival rates. However, the timing of PEG placement remains a significant issue for clinicians.
  
  
  OBJECTIVE
  To analyse the characteristics of ALS patients at the moment of PEG placement and their progression.
  
  
  METHODS
  Descriptive retrospective study including patients diagnosed with ALS and PEG who were assessed during the 2005-2014 period in our hospital. Nutritional parameters and respiratory function were assessed for all patients, as well as their progression. The data was analysed using SPSS15.
  
  
  RESULTS
  37 patients were included (56.8% men, 43.2% women) with an average age of 60 at diagnosis, and an average age of 63.1 at PEG placement. 48.6% started with spinal affection and 51.4%, with bulbar affection. 43.2% of the patients received oral nutritional supplements prior to PEG placement for a mean period of 11.3 months. The mean forced vital capacity at diagnosis was 65.45±13.67%, with a negative progression up to 39.47±14.69% at the moment of PEG placement. 86.5% of patients required non-invasive positive-pressure ventilation. 86.5% presented with dysphagia, 64.9% with weight loss > 5-10% from their usual weight, 8.1% with low Body Mass Index, 27% with malnutrition and 73% with aworsened breathing function; therefore, 100% met the criteria for PEG placement according to our protocol. The period on enteral feeding was extended for 10.1 months with a mortality of 50% during the first 6 months from PEG placement.
  
  
  CONCLUSIONS
  There is evidence of a 3-year delay between diagnosis and PEG placement, with a survival rate of 50% at 6 months from PEG insertion. Further studies are required to establish whether an earlier placement might increase survival rates.
authors.affiliation: UGC Endocrinología y Nutrición. Hospital Universitario Reina Sofía, Córdoba. España.. inmapri@hotmail.com.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Prior-Sánchez
authors.affiliation: UGC Endocrinología y Nutrición. Hospital Universitario Reina Sofía, Córdoba. España.. aurita.dhm@gmail.com.
authors.forename: Aura Dulcinea
authors.initials: AD
authors.lastname: Herrera-Martínez
authors.affiliation: UGC Endocrinología y Nutrición. Hospital Universitario Reina Sofía, Córdoba. España.. carmentenoriojimenez@hotmail.com.
authors.forename: Carmen
authors.initials: C
authors.lastname: Tenorio Jiménez
authors.affiliation: UGC Endocrinología y Nutrición. Hospital Universitario Reina Sofía, Córdoba. España.. cmmerinomjmolina@hotmail.com.
authors.forename: María José
authors.initials: MJ
authors.lastname: Molina Puerta
authors.affiliation: UGC Endocrinología y Nutrición. Hospital Universitario Reina Sofía, Córdoba. España.. contentine@yahoo.es.
authors.forename: Alfonso Jesús
authors.initials: AJ
authors.lastname: Calañas Continente
authors.affiliation: UGC Endocrinología y Nutrición. Hospital Universitario Reina Sofía, Córdoba. España.. gmgendocrino@hotmail.com.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Manzano García
authors.affiliation: UGC Endocrinología y Nutrición. Hospital Universitario Reina Sofía, Córdoba. España.. mamolag@yahoo.es.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Gálvez Moreno
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D013030:Spain; D016019:Survival Analysis