title: Feasibility and results of pull-percutaneous endoscopic gastrostomy for enteral nutrition in adults with severe cerebral palsy.
abstract: Eating and swallowing impairments often get worse as patients with severe cerebral palsy (CP) get older, creating increased demand for percutaneous endoscopic gastrostomy (PEG) tube placement. Here we investigated the feasibility, safety, adverse events (AEs) and outcomes of PEG in adult CP.
  
  
  
  We performed a retrospective study of 26 consecutive severe adult (age: 28 [19-48] yrs) CP patients who underwent pull-PEG tube placement under general anesthesia between 2005 and 2012 (median follow-up: 23 [6-64] months) at the same tertiary hospital centre.
  
  
  
  The procedure was a technical success for 19 patients (BMI: 13.8 [10.7-21.4]) with (n = 11) or without (n = 8) previous respiratory disorder. Indications were mainly swallowing disorders (n = 14) and inadequate oral intake (n = 8). Early AEs were 7 transient oxygen needs, 3 local wound infections and 2 transient ileus. Long-term AEs were 9 non-severe gastrostomy incidents. There was no significant improvement in neurological status but respiratory function was improved in 6 patients and enteral nutrition enabled a significant median weight gain of 4.2 [1-8.8] kg (P < 0.01). Quality-of-life assessed by relatives and the healthcare team was improved in 13/16 and 13/15 cases respectively. AEs and outcomes did not differ significantly with previous respiratory disorder or nutritional status.
  
  
  
  PEG tube placement is feasible in adult CP, although the risk of failure is increased by anatomical specificities. Previous respiratory disorders and undernourishment did not increase AE rates or modify outcomes. There were positive changes over time for nutritional status and perceived quality-of-life, but no neurological improvement.
authors.affiliation: Université de Versailles Saint-Quentin-en-Yvelines, INSERM U1179, équipe Thérapeutiques Innovantes et Technologies Appliquées aux Troubles Neuromoteurs, UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France; Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Davout
authors.affiliation: Médecine Physique et Réadaptation, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France.
authors.forename: Celia
authors.initials: C
authors.lastname: Rech
authors.affiliation: Université de Versailles Saint-Quentin-en-Yvelines, INSERM U1179, équipe Thérapeutiques Innovantes et Technologies Appliquées aux Troubles Neuromoteurs, UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France; Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France.
authors.forename: Mouna
authors.initials: M
authors.lastname: Hanachi
authors.affiliation: Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France.
authors.forename: Frederique
authors.initials: F
authors.lastname: Barthod
authors.affiliation: Université de Versailles Saint-Quentin-en-Yvelines, INSERM U1179, équipe Thérapeutiques Innovantes et Technologies Appliquées aux Troubles Neuromoteurs, UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France; Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Melchior
authors.affiliation: Université de Versailles Saint-Quentin-en-Yvelines, INSERM U1179, équipe Thérapeutiques Innovantes et Technologies Appliquées aux Troubles Neuromoteurs, UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France; Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France. Electronic address: pascal.crenn@aphp.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Crenn
mesh_terms: D000328:Adult; D002547:Cerebral Palsy / Q000628:therapy*; D003680:Deglutition Disorders / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cerebral palsy; Chronic disease; Enteral nutrition; Percutaneous endoscopic gastrostomy (PEG); Swallowing disorders; Undernutrition