Abstract Details

Title Retrospective Review of Outcomes After Intervention for Enteral Nutrition in ALS Patients Enrolled in Midwest Multi-disciplinary ALS Clinics

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 11-001

Objective Determine whether malnutrition versus forced vital capacity (FVC) is predictive of early post-operative morbidity/mortality for percutaneous endoscopic gastrostomy (PEG).

Background Practice parameters support PEG in ALS patients given benefits regarding weight stabilization and survival, despite increased periprocedural complications compared to other diseases. FVC less than 50% or malnutrition may be associated with mortality following PEG; however, these have not been consistently replicable.

Design/Methods Retrospective review of clinically diagnosed ALS patients treated at 3 Midwest multi-disciplinary ALS clinics (University of Kansas, Nebraska, Missouri) from January 2009 to September 2020 referred for PEG. Data included demographics, disease characteristics, key PEG related dates/outcomes (PEG placement, hospital readmission post procedure, death and/or permanent ventilation). Standard descriptive statistics and one-way ANOVA were used for comparison. Data from University of Kansas was available for analysis.

Results

One hundred ninety-eight patients were included with median age of 65.5 years. Majority (54.5%) were female with bulbar onset ALS (58.6%). 30-day mortality was 4.5% (N=9) and 30-day re-admission 8.1% (N=16). Of those with 30-day mortality, 89% (N=8) had weight loss greater than 10% from usual body weight (UBW). There was no difference in outcomes based on FVC less than 50% and BMI less than 18.5. Most common major complications included abscess and aspiration pneumonia (both N=4, 2%) and minor complications were pain (N=75, 38.1%) and tube migration (N=25, 12.7%).

Conclusions

Rates of major/minor complications and 30-day mortality related to PEG were similar compared to prior studies in ALS. The increased 30-day mortality in those with greater than 10% UBW loss at time of PEG will have to be confirmed with additional site data. No difference in outcomes based on FVC may suggest improved perioperative management at PEG placement and/or alternative explanations for increased complications in ALS patients. Data for additional centers will be presented at time of the meeting.

Authors/Disclosures
Timothy R. Fullam, MD, FAAN PRESENTER	Dr. Fullam has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amylyx. Dr. Fullam has received publishing royalties from a publication relating to health care. Dr. Fullam has received personal compensation in the range of $500-$4,999 for serving as a ALS CDRMP Programmatic Panel with Department of War.
	No disclosure on file
Swathy Chandrashekhar, MD (University of Kansas Medical Center)	Dr. Chandrashekhar has received publishing royalties from a publication relating to health care.
Omar Jawdat, MD (The University of Kansas Medical Center)	Dr. Jawdat has nothing to disclose.
Brian Ghafari-Naraghi, RN, BSN	Mr. Ghafari-Naraghi has nothing to disclose.
Ezequiel A. Piccione, MD, FAAN (UNMC)	Dr. Piccione has nothing to disclose.
J. Americo M. Fernandes, Jr., MD, FAAN (University of Nebraska Medical Center)	Dr. Fernandes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Columbia University. The institution of Dr. Fernandes has received research support from MGH philanthropy (Clene, Seelos, UCB, Biohaven, Prilenia, Denali Therapeutics, Calico Life Sciences. The institution of Dr. Fernandes has received research support from Columbia University. The institution of Dr. Fernandes has received research support from PTC Therapeutics. The institution of Dr. Fernandes has received research support from Clene.
Richard J. Barohn, MD, FAAN (University of Missouri)	Dr. Barohn has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for NuFactor. The institution of Dr. Barohn has received research support from FDA OPD R01. Dr. Barohn has received intellectual property interests from a discovery or technology relating to health care.
Katy Eichinger, PhD, PT, DPT, NCS (University of Rochester)	Dr. Eichinger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Fulcrum. Dr. Eichinger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Avidity. Dr. Eichinger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for DyneTherapeutic. Dr. Eichinger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Eichinger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TRiNDS. The institution of Dr. Eichinger has received research support from Charcot Marie Tooth Association. The institution of Dr. Eichinger has received research support from Muscular Dystrophy Association. Dr. Eichinger has received intellectual property interests from a discovery or technology relating to health care.

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