title: Enteral feeding through endoscopic gastrostomy in amyotrophic lateral sclerosis patients.
abstract: BACKGROUND
  Dysphagia is common in amyotrophic lateral sclerosis (ALS) and may result in malnutrition. Endoscopic gastrostomy (PEG) is recommended when oral feeding is unsafe. This work aims to assess the effectiveness and safety of PEG feeding on improving nutritional and prognostic parameters in ALS patients.
  
  
  METHODS
  Observational and retrospective study using records from ALS patients referred for gastrostomy. Age, gender and mortality data were collected. NRS 2002, body mass index (BMI), serum albumin, transferrin and total cholesterol were recorded at the time of PEG (T0) and repeated after 3 months (T3). The evolution of these parameters was analysed and compared to survival.
  
  
  RESULTS
  Data from 37 ALS patients (18 men/19 women) aged 43-88 years (mean: 69 years). All patients presented NRS 2002 ≥ 3 points. On average, patients underwent gastrostomy 11 months after diagnosis. No major procedural complications occurred. Mean survival after diagnosis was 22.2 months. Mortality rate at 3 months was 21.6% with a mean survival after PEG of 11.2 months. Albumin, transferrin and cholesterol levels increased from T0 to T3 without reaching statistical significance. Higher albumin (R = 0.3) and transferrin (R = 0.4) at admission tend to be positively correlated with survival. Mean BMI was similar at the two moments but higher initial values were associated with better outcome (R2 = 0.39, p < 0.05).
  
  
  CONCLUSIONS
  PEG is a safe and effective technique for enteral feeding and should be considered early in ALS patients with dysphagia. Higher BMI predicts longer survival. The association between higher serum proteins and survival must be confirmed in further studies.
authors.affiliation: Gastroenterology Department. Hospital Garcia de Horta. GENE-Artificial Feeding Team. Almada, Portugal. goncalo.n@hotmail.com.
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Nunes
authors.forename: Carla Adriana
authors.initials: CA
authors.lastname: Santos
authors.forename: Miguel
authors.initials: M
authors.lastname: Grunho
authors.forename: Jorge
authors.initials: J
authors.lastname: Fonseca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000628:therapy*; D015992:Body Mass Index; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Amyotrophic lateral  sclerosis. Nutrition.  Gastrostomy. PEG.