Percutaneous endoscopic gastrostomy in atypical parkinsonian syndromes: survival and aspiration outcomes from a retrospective international cohort.

INTRODUCTION

Dysphagia frequently occurs in movement disorders, leading to malnutrition and aspiration. Percutaneous endoscopic gastrostomy (PEG) provides nutrition directly into the stomach, bypassing the dysfunctional swallow. However, PEG insertion is a complex decision, both clinically and ethically. Although PEG outcomes are reported in other neurological disorders, there is limited research in atypical parkinsonian syndromes such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Insertion rates remain variable, reflecting a paucity of research and lack of consistent guidelines. Basic mortality and morbidity data would help inform practice. To our knowledge, this is the first international study of PEG insertion and its impact on survival and aspiration pneumonia in atypical parkinsonian syndromes.

METHOD: This was an international retrospective study of 72 patients with MSA, PSP or CBD. Survival was recorded from reported onset of dysphagia to death. Secondary outcomes included hospital admission rate for aspiration pneumonia.

RESULTS

Median survival was 17.4 months (95% confidence interval [CI] 14.0-24.9) in non-PEG patients versus 48.8 months (95% CI 44.8 to not reached) in PEG patients, hazard ratio (HR) 0.38 (95% CI 0.18-0.81; p=0.013). PEG was not associated with reduced risk of aspiration pneumonia; 0.76 versus 0.68 admissions per patient-year, incidence rate ratio (IRR) 1.41 (95% CI 0.74-2.68; p=0.297).

CONCLUSION

PEG insertion may improve survival in atypical parkinsonian syndromes, though we found no evidence of reduced aspiration risk. Given the rarity of these conditions, international registries may help to determine the safety and efficacy of PEG use.