Nutritional prognostic factors for survival in amyotrophic lateral sclerosis patients undergone percutaneous endoscopic gastrostomy placement

Barone, M.; Viggiani, Maria Teresa; Introna, Alessandro; D’Errico, Eustachio; Scarafino, Antonio; Iannone, Andrea; Leo, Alfredo Di; Simone, Isabella Laura

doi:10.1080/21678421.2019.1643374

Cited by 16 publications

(17 citation statements)

References 25 publications

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“…Body fat might be the major factor involved in energy metabolism resulting in weight variation in ALS patients. A study by Barone et al 20 found that FM was significantly lower in underweight patients and it increased in patients with a higher BMI, while no significant difference was found in FFM. This study also observed lower BMI and FM in patients with significant weight loss.…”

Section: Discussionmentioning

confidence: 94%

Correlation of weight and body composition with disease progression rate in patients with amyotrophic lateral sclerosis

Sun

Cai

et al. 2022

Sci Rep

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This study aims to observe the nutritional status of Chinese patients with amyotrophic lateral sclerosis (ALS), further investigating its effect on disease progression. One hundred consecutive newly diagnosed ALS patients and fifty controls were included. Weight and body composition were measured by bioelectrical impedance analysis at baseline and follow-ups. The revised ALS functional rating scale (ALSFRS-R) was used to calculate the rate of disease progression. Patients with ALS had a significantly lower BMI than controls, while no significant difference was found in body composition. Weight loss occurred in 66 (66%) and 52 (67.5%) patients at diagnosis and follow-up, respectively. Patients with significant weight loss (≥ 5%) at diagnosis had significantly lower BMI, fat mass (FM), and FM in limbs and trunk than those without. Fat-free mass (FFM), FM, and FM in limbs were significantly decreased along with weight loss at follow-up (p < 0.01). Patients with lower visceral fat index, lower proportion of FM, and higher proportion of muscle mass at baseline progressed rapidly during follow-ups (p < 0.05). Multivariate linear regression showed that FFM and weight at follow-up were independently correlated with disease progression rate at follow-up (p < 0.05). Weight loss is a common feature in ALS patients, along with muscle and fat wasting during the disease course. Body composition may serve as a prognostic factor and provide guidance for nutritional management in ALS patients.

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Section: Discussionmentioning

confidence: 94%

Correlation of weight and body composition with disease progression rate in patients with amyotrophic lateral sclerosis

Sun

Cai

et al. 2022

Sci Rep

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“…Safer placement may still be achieved in patients with a lower FVC, with concomitant noninvasive ventilatory support [71]. As malnutrition is an independent risk factor for death after percutaneous gastrostomy [40], early placement is recommended, potentially even before the threshold of 10 % weight loss, as suggested by the European Federation of Neurological Societies (EFNS) [70].…”

Section: Recommendationmentioning

confidence: 99%

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

et al. 2020

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Main recommendationsESGE recommends considering the following indications for enteral tube insertion: (i) clinical conditions that make oral intake impossible (neurological conditions, obstructive causes); (ii) acute and/or chronic diseases that result in a catabolic state where oral intake becomes insufficient; and (iii) chronic small-bowel obstruction requiring a decompression gastrostomy.Strong recommendation, low quality evidence.ESGE recommends the use of temporary feeding tubes placed through a natural orifice (either nostril) in patients expected to require enteral nutrition (EN) for less than 4 weeks. If it is anticipated that EN will be required for more than 4 weeks, percutaneous access should be considered, depending on the clinical setting.Strong recommendation, low quality evidence.ESGE recommends the gastric route as the primary option in patients in need of EN support. Only in patients with altered/unfavorable gastric anatomy (e. g. after previous surgery), impaired gastric emptying, intolerance to gastric feeding, or with a high risk of aspiration, should the jejunal route be chosen.Strong recommendation, moderate quality evidence.ESGE suggests that recent gastrointestinal (GI) bleeding due to peptic ulcer disease with risk of rebleeding should be considered to be a relative contraindication to percutaneous enteral access procedures, as should hemodynamic or respiratory instability.Weak recommendation, low quality evidence.ESGE suggests that the presence of ascites and ventriculoperitoneal shunts should be considered to be additional risk factors for infection and, therefore, further preventive precautions must be taken in these cases.Weak recommendation, low quality evidence.ESGE recommends that percutaneous tube placement (percutaneous endoscopic gastrostomy [PEG], percutaneous endoscopic gastrostomy with jejunal extension [PEG-J], or direct percutaneous endoscopic jejunostomy [D-PEJ]) should be considered to be a procedure with high hemorrhagic risk, and that in order to reduce this risk, specific guidelines for antiplatelet or anticoagulant use should be followed strictly.Strong recommendation, low quality evidence.ESGE recommends refraining from PEG placement in patients with advanced dementia.Strong recommendation, low quality evidence.ESGE recommends refraining from PEG placement in patients with a life expectancy shorter than 30 days.Strong recommendation, low quality evidence*.

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“…Studies on the prognosis after PEG in patients with ALS have not always yielded consistent results, but the following have been reported as poor prognostic factors: older age at onset, 2-4 bulbaronset ALS, 5 short time from onset to PEG, 6 decreased BMI, 2,4,7 decreased FVC, 5,[8][9][10][11] and increased PaCO 2 . 6,8 The results of multivariate analysis in our study showed that onset age ≥65 years, SVC ≤57.4, and FVC ≤57.3 were prognostic factors after PEG.…”

Section: Prognostic Factors After Pegmentioning

confidence: 99%

“…been conducted on the prognosis after PEG in patients with ALS. [2][3][4][5][6][7][8][9][10][11] Nutritional status and respiratory function are associated with prognosis after PEG. [2][3][4][5][6][7][8][9][10][11] Forced vital capacity (FVC) is one of the prognostic factors after PEG 5,6,[8][9][10][11] and is also recommended as part of the risk assessment for patients being considered for PEG.…”

mentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11] Nutritional status and respiratory function are associated with prognosis after PEG. [2][3][4][5][6][7][8][9][10][11] Forced vital capacity (FVC) is one of the prognostic factors after PEG 5,6,[8][9][10][11] and is also recommended as part of the risk assessment for patients being considered for PEG. 12,13 However, FVC is inaccurate in ALS associated with orofacial palsy because air leaks between the mouthpiece and the mouth, 14 and it may induce bronchospasm or exhaust the patient.…”

mentioning

confidence: 99%

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Slow vital capacity as a useful indicator of the prognosis after percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis

Ueno

Haga

Arai

et al. 2022

Acta Neuro Scandinavica

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Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by dysphasia, dysarthria, respiratory failure, and limb weakness due to upper and lower motor neuron lesions. 1 Although many clinical trials have been conducted, end-of-life counselling is important for patient care because ALS remains an incurable disease. Depending on ethical considerations and the patient's nutritional status and respiratory status, gastrostomy or tracheostomy and permanent ventilatory support may be occasionally considered.Percutaneous endoscopic gastrostomy (PEG) is the commonest method for creating a gastrostomy and many clinical studies have

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Nutritional prognostic factors for survival in amyotrophic lateral sclerosis patients undergone percutaneous endoscopic gastrostomy placement

Cited by 16 publications

References 25 publications

Correlation of weight and body composition with disease progression rate in patients with amyotrophic lateral sclerosis

Correlation of weight and body composition with disease progression rate in patients with amyotrophic lateral sclerosis

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

Slow vital capacity as a useful indicator of the prognosis after percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis

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