Objective: To describe outcomes of PEG feeding in Parkinson’s and related disorders.

Background: PEG feeding provides a means of getting food, liquid and medication safely into the stomach in people with dysphagia. There is little guidance on use of PEG in Parkinson’s but information of survival and complications post PEG might inform difficult discussions with patients and family.

Method: 83 cases were identified by review of PEG registers and by searching the administrative databases in 2 large UK university hospitals (2008-2017). A retrospective case note review was undertaken. Care processes and outcomes were assessed. Each hospital had a population of about 1000 Parkinson’s patients.

Results: Diagnosis: Parkinson’s disease (PD), 48; PD dementia,10; Progressive supranuclear palsy, 10; Multiple system atrophy,5; Dementia with Lewy Bodies, 3; Vascular parkinsonism, 7. Median age 78 year [IQR 72-82]; female 29 (35%). HoehnYahr (HY) Stage (for PD only) HY2=2%, HY3=18%, HY4=41%, HY5 = 39%. Care Processes. Advance care plan in place prior to admission, 18 (22%); PEG inserted during emergency admission, 68 (82%); Speech therapy assessment, 74(90%); Documented risk/benefit discussion, 69 (83%). Rate of PEG insertion for Parkinsonian disorders: 4.1 per year per 1000 people with Parkinson’s. Rate of insertion was stable over time. Outcomes. Median total length of stay, 50 days [IQR 28-69]; Median length of stay post PEG, 20 days [IQR 8-30]; Median survival, 532 days [IQR 151-850] (data from single site, n=36); 30 day mortality, 3 (8.3%) (data from single site, n=36); Step up in care on discharge (institutionalization), 22/65(34%). Complications: None 48 (59%); Aspiration 17 (20%); Buried bumper 2 (2%); PEG site infection 6 (8%; Bowel perforation 1 (1%).

Conclusion: PEG insertion in Parkinson’s is an infrequent event. Most patients are severely disabled. Most PEGs occurred during a non elective admission. One third of patients with PEG insertion needed a significant step up in care on discharge. Recommendations: 1. Markers of advanced disease should prompt advanced care planning including discussion of dysphagia management; 2. Discussions about PEG feeding in Parkinsonian conditions should include information about post PEG survival, complications and risk of institutionalization; 3. Further data is needed on quality of life post PEG. [Interim data presented at Parkinson’s Foundation CLC, Phoenix AZ April 2019.]

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MDS Abstracts - https://www.mdsabstracts.org/abstract/outcomes-of-percutaneous-endoscopic-gastrostomy-peg-feeding-in-parkinsons/