We sought to determine the incidence of PEG placement in patients with PD, AD, or ALS, and describe yearly trends from 1990 to 2010.

Dysphagia occurs in 72-87% of Parkinson’s disease (PD) patients, and aspiration pneumonia remains a leading cause of death in these patients. Although percutaneous endoscopic gastrostomy (PEG) is commonly used for neurological diseases, such as stroke, the evidence does not support its use in PD and Alzheimer’s disease (AD) patients. In contrast, studies have showed that PEG prolongs survival in amyotrophic lateral sclerosis (ALS) patients. 

Secondary analysis of a national database from 1990 to 2010 was conducted. Cases were identified using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes for PD, AD, and ALS, and CPT code for PEG. Descriptive analysis was performed for all years, individually and in aggregate, and binomial regression model was used to determine the trend of PEG use over the 21 years in each group.

PEG tube placement was lower with each successive year, on average 3.5% lower per year (P < .001) in PD, 6.7% lower per year (P < .001) in AD, and 0.3% lower per year (P = .007) in ALS.  The incidence of PEG placement averaged over the first 5 years (1990-1994) vs the last 5 years (2005-2009) was 1.9% and 1.4% for PD, 2.7% and 0.9% for AD, and 11.3% and 11.1% in ALS. 

Our results show that use of PEG in ALS over the past two decades is unchanged, while the rate among PD and AD patients is declining. However, approximately 1% of PD and AD patients still undergo PEG placement despite limited evidence to support its use. Further research should explore clinician practices and patient awareness of PEG in these disorders.