Table 6

Advantages and disadvantages of PEG, RIG, and NGT (nasogastric tube) hydration and nutrition in MND patients

*Some patients delay decision on non-invasive ventilation until VC is <50% predicted or until they develop symptoms of respiratory insufficiency.
PEG Standardised procedure for MND patients; risks and benefits well documented; tubes widely available and standardisedRequires sedation, introduction of endoscope tube, recumbency. Not recommended if VC <50%; requires admission to hospital (4–5 days). Infection may occur around gastrostomy site
RIG Only fine bore NGT tube required (for introduction of air); only local anaesthetic needed; use of the skin level Entristar tube is satisfactory; tolerated well by patients with VC <50%; can be used with NIVRequires admission to hospital (4 days) but can be performed as day case in patients with good respiratory function and early disease. Local infection may occur
NGT Minor, non-invasive procedure; possible to place in virtually all patients; good for maintaining hydration and avoiding intravenous fluids/feeding in the short term. Should be considered as temporary measure in some patients. We use NGT to improve patients’ fitness before RIG*Nasopharyngeal discomfort, pain or even ulceration if used for more than 6–8 weeks; intrusive and unsightly for active patients; checking for displacement before feeding commences can be a burden for carers; community support varies