A retrospective study of percutaneous endoscopic gastrostomy in ALS patients during the BDNF and CNTF trials

Percutaneous endoscopic gastrostomy (PEG) provides a reliable route for nut rition and hydration in ALS patients with dysphagia. We performed a retrosp ective analysis of the CNTF and BDNF databases to determine the clinical st atus of ALS patients within 30 days preceding PEG insertion. This analysis revealed an approximately 50% reduction of function across multiple measure s of ALS disease status. A trend to earlier intervention with PEG was appar ent upon review of published studies and the CNTF and BDNF studies. By comp aring the rate of decline pre- and post-PEG, nutritional supplementation vi a PEG stabilized the weight loss experienced by patients. Death within 30 d ays post-PEG was associated with a marked reduction in forced vital capacit y (FVC) and identified a group of ALS patients in whom PEG should be cautio usly performed. These data emphasize the importance of sequential measureme nt of FVC in managing ALS patients to guide the timing of nutritional inter vention with PEG. (C) 1999 Elsevier Science B.V. All rights reserved.