Gastrostomy use in motor neurone disease (MND): A review, meta-analysis and survey of current practice

Abstract

Gastrostomy feeding is commonly used to support MND patients with dysphagia. In this paper we review three main methods of gastrostomy insertion (PEG, RIG, PIG); conduct a meta-analysis of mortality data following gastrostomy; and present a survey of current practice. A review of the literature revealed a lack of high quality evidence to indicate the optimal method and timing for gastrostomy insertion in patients with MND. A survey of 20 MND clinics demonstrated a clinic-based variability of gastrostomy practices due to factors such as clinician preference, availability of method, and patient respiratory function. The meta-analysis demonstrated that the estimate of the absolute difference in mortality rates was 2.1% higher for PEG (− 6.3%, + 11.2%), suggesting that RIG and PIG methods may be safer than PEG. These results and observations highlight the need for more research to evaluate and compare the safety of the differerent gastrostomy insertion methods in MND care.

Key words::

• Amyotrophic lateral sclerosis
• motor neuron disease
• gastrostomy

Acknowledgements

We thank Pete Laud, Statistical Services Unit, University of Sheffield for assisting with the statistical analysis (meta-analysis) reported in this manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study was sponsored by Sheffield Teaching Hospitals NHS Foundation Trust and supported jointly by the Motor Neurone Disease Association (MNDA) and the Sheffield Institute for Translational Neuroscience (SITraN).