Abstract

Enteral feeding is offered to many patients diagnosed with Motor Neuron Disease (MND) experiencing dysphagia and impaired nutritional status. The evidence for survival advantage after PEG insertion is weakly positive but inconclusive. We performed a retrospective review of the database maintained by the Preston MND care and research centre to evaluate the impact of PEG placement on survival of patients with MND. Between 2000 and 2010, 505 patients were diagnosed with MND. Survival analysis was carried out using Kaplan Meier, Logrank and Wilcoxon and Cox regression methods. Complete data was available for 487 patients, of these 134 (27.5%) had a PEG. Female patients and those with bulbar onset were more likely to have a PEG (p=0.0218, p<0.001 respectively). The mean time from onset of symptoms to gastrostomy was 2.87 years and from diagnosis to gastrostomy 321 days. Median survival in the PEG group was 2.53 years (95% CI 2.09 to 2.97), compared to 2.4 years (95% CI 2.15 to 2.66) in the non-PEG group (Log Rank p=0.5188). The median survival time after PEG tube insertion was 260 days (95% CI 207 to 312). Age, sex, riluzole treatment and site of onset did not have a significant effect on survival after PEG insertion. Our retrospective review did not find a survival advantage with PEG. However, the retrospective nature of our study and lack of randomisation are potential limitations. A prospective study to evaluate the survival advantage of PEG in this challenging clinical population is needed to provide further evidence to inform and influence best clinical practice.