Kirstein Martha M, Körner Sonja, Schneider Andrea, Manns Michael P, Petri Susanne, Voigtländer Torsten
Departments of Gastroenterology, Hepatology and Endocrinology.
Neurology, Hannover Medical School, Hannover, Germany.
Eur J Gastroenterol Hepatol. 2018 Mar;30(3):257-262. doi: 10.1097/MEG.0000000000001054.
Amyotrophic lateral sclerosis (ALS) is a fatal degenerative disease of the motor nervous system, which is associated with severe loss of weight. Enteral nutrition through percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) is generally recommended upon disease progression. There is no standard endoscopic method that should preferentially be performed. The aim of this study was to compare the number of adverse events, complication-free survival (CFS), and overall survival (OS) in patients who received PEG or PEG-J.
All patients with ALS presenting for PEG or PEG-J placement to the Endoscopic Unit of Hannover Medical School, Germany, between 2009 and 2015 were retrospectively analyzed.
Demographics were similar for patients receiving PEG (n=43) and PEG-J (n=39). The median intervention time and the absolute dose of propofol were significantly longer and, respectively, higher for patients with PEG-J (P=0.001 and 0.013). Intervention-related complications leading to hospitalization were significantly more frequent in patients who received PEG-J (36 vs. 4, P=0.001). The median CFS was significantly shorter in patients who received PEG-J compared with PEG (5 vs. 14 months, P=0.007). There was no difference in OS.
Intervention-related complications were more frequent and the median CFS was shorter in patients who received PEG-J, whereas there was no difference in OS. Given the poor prognosis of patients with ALS, our data provide first evidence that PEG might be the better tolerable option, with fewer complications. The decision on which nutritional system is implanted should be evaluated individually.
肌萎缩侧索硬化症（ALS）是一种致命的运动神经系统退行性疾病，常伴有严重体重减轻。疾病进展时，一般建议通过经皮内镜下胃造口术（PEG）或带空肠延长的经皮内镜下胃造口术（PEG-J）进行肠内营养。目前尚无应优先采用的标准内镜方法。本研究旨在比较接受PEG或PEG-J治疗患者的不良事件数量、无并发症生存期（CFS）和总生存期（OS）。
对2009年至2015年间在德国汉诺威医学院内镜科接受PEG或PEG-J置管的所有ALS患者进行回顾性分析。
接受PEG治疗的患者（n = 43）和接受PEG-J治疗的患者（n = 39）的人口统计学特征相似。PEG-J患者的中位干预时间和丙泊酚绝对剂量显著更长、更高（P = 0.001和0.013）。接受PEG-J治疗的患者中，导致住院的干预相关并发症明显更常见（36例对4例，P = 0.001）与接受PEG治疗的患者相比，接受PEG-J治疗的患者的中位CFS显著更短（5个月对14个月，P = 0.007）。OS无差异。
接受PEG-J治疗的患者干预相关并发症更常见，中位CFS更短，而OS无差异。鉴于ALS患者预后较差，我们的数据首次证明PEG可能是耐受性更好、并发症更少的选择。植入哪种营养系统的决定应个体化评估。
