Advantages and disadvantages of PEG, RIG, and NGT (nasogastric tube) hydration and nutrition in MND patients
| Procedure | Advantages | Disadvantages |
|---|---|---|
| *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 standardised | Requires 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 NIV | Requires 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 |