Survival of patients with ALS following institution of enteral feeding is related to pre-procedure oximetry: A retrospective review of 98 patients in a single centre

A retrospective review was carried out on the influence of pre-procedure respiratory assessment on survival of patients with amyotrophic lateral sclerosis (ALS) requiring nutritional support with either a gastrostomy or a nasogastric feeding tube. Over a five-year period 98 patients ( 49 male, 49 female; median age 61 years, range 26 - 86 years) with ALS were referred for enteral feeding with either radiological inserted gastrostomy ( RIG), percutaneous endoscopic gastrostomy ( PEG) or nasogastric tube (NG). Case notes review was performed to record patient age, sex, pre-procedure respiratory assessment, method of enteral feeding and survival post-procedure. Kaplan-Meier survival curves were constructed for each group, with Cox regression analyses performed in order to establish the effect of each variable on outcome. Median survival ( with 95% confidence intervals) following RIG, PEG and NG was 6.31 months (4.58 - 8.04 months), 7.13 months ( 4.81 - 9.45 months) and 0.95 months (0.00 - 2.77 months), respectively. The survival advantage between RIG and PEG was not statistically significant (p=0.50), but for NG versus RIG and PEG groups combined, there was a significant difference (p=0.03). For patients with normal overnight oximetry, median survival was 8.54 months (3.88 - 13.21 months), compared to 4.80 months (1.20 - 8.39 months) in the abnormal oximetry group (p=0.03; relative risk 1.97). It is concluded that RIG and PEG are equivalent in terms of post-procedure survival. Abnormal oximetry prior to the procedure is a significant indicator of post-procedure survival.