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Review
. 2023 Aug 10;8(8):CD004030.
doi: 10.1002/14651858.CD004030.pub4.

Enteral tube feeding for amyotrophic lateral sclerosis/motor neuron disease

Adrienne Sulistyo #  1   2 , Agessandro Abrahao #  3 , Maria Eliza Freitas  4 , Benjamin Ritsma  5 , Lorne Zinman  3
Affiliations
Review

Enteral tube feeding for amyotrophic lateral sclerosis/motor neuron disease

Adrienne Sulistyo et al. Cochrane Database Syst Rev. .

Abstract
in English, Korean

Background: Maintaining adequate nutrition is critical for people with amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND). Enteral tube feeding is offered to people experiencing difficulty swallowing (dysphagia) to prevent weight loss and aspiration pneumonia. Among the types of enteral tube feeding, percutaneous endoscopic gastrostomy (PEG) is the typical procedure offered to people with ALS and will be mainly discussed here.

Objectives: To examine the effectiveness of percutaneous endoscopic gastrostomy or other enteral tube feeding in people with ALS, compared to oral feeds without enteral tube feeding on: 1. survival; 2. nutritional status; 3. quality of life. To examine the incidence of minor and major complications of percutaneous endoscopic gastrostomy (PEG) and other enteral tube feeding procedures in people with ALS.

Search methods: On 3 January 2020 and 6 February 2021, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE. Embase, ClinicalTrials.gov and WHO ICTRP. We screened the results to identify randomized controlled studies on enteral tube feeding in ALS. We reviewed all references from the search in published articles to identify any additional references.

Selection criteria: We included randomized controlled trials (RCTs), quasi-RCTs, and cross-over trials evaluating the effectiveness and complications of PEG or other enteral tube feeding placement in ALS.

Data collection and analysis: We used standard methodological procedures expected by Cochrane.

Main results: We found no RCTs or quasi-RCTs comparing the effectiveness of enteral tube feeding versus oral feeds without enteral tube feeding.

Authors' conclusions: There are no RCTs or quasi-RCTs to indicate whether enteral tube feeding is effective compared to continuation of oral feeding for any of the outcome measures. Such RCTs are very unlikely to be performed for ethical reasons. RCTs evaluating the effect of different enteral tube insertion techniques and timings of tube placement on survival and quality of life of people with ALS dysphagia are feasible and warranted.

배경: 운동 신경 질환(MND)으로도 알려진 근위축성측삭경화증(ALS) 환자에게는 적절한 영양을 유지하는 것이 중요하다. 체중 감소와 흡인성 폐렴을 예방하기 위해 삼킴 곤란(삼킴곤란)을 경험하는 사람들에게 경장 영양이 제공된다. 경장 영양 중 경피적 내시경적 위루술(PEG)은 ALS 환자에게 제공되는 대표적인 시술이며 여기서 주로 논의될 것이다. 목적: ALS 환자의 경피 내시경 위루술 또는 기타 경장 영양의 효과를 장관 영양이 없는 경구 영양과 비교하여: 1. 생존 2. 영양 상태 3. 삶의 질. ALS 환자에서 경피적 내시경 위루술(PEG) 및 기타 경장 영양 절차의 경미한 합병증 및 주요 합병증 발생률을 조사한다. 검색 전략: 2020년 1월 3일과 2021년 2월 6일에 Cochrane Neuromuscular Specialized Register, CENTRAL, MEDLINE을 검색했다. Embase, ClinicalTrials.gov 및 WHO ICTRP. ALS에서 경장 영양에 대한 무작위 대조 연구를 식별하기 위해 결과를 선별했다. 게시된 기사에서 검색한 모든 참조를 검토하여 추가 참조를 식별했다. 선정 기준: ALS에서 PEG 또는 기타 경장 영양식 위치의 효과와 합병증을 평가하는 무작위 대조 시험(RCT), 준 RCT 및 교차 시험을 포함했다. 자료 수집 및 분석: 코크란에서 기대하는 표준 방법론적 절차를 사용했다. 주요 결과: 경장 영양과 경장 영양을 사용하지 않는 경구 영양의 효과를 비교하는 RCT 또는 준 RCT를 찾지 못했다. 연구진 결론: 결과 측정에 대해 장내 튜브 영양이 경구 영양의 지속과 비교하여 효과적인지 여부를 나타내는 RCT 또는 준 RCT는 없다. 이러한 RCT는 윤리적 이유로 수행될 가능성이 매우 낮다. ALS 삼킴곤란 환자의 생존과 삶의 질에 대한 다양한 경장 영양 삽입 기술 및 튜브 위치 시기의 효과를 평가하는 RCT가 실현 가능하고 타당하다.

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Conflict of interest statement

AS: none known.

AA: none known. AA is a specialist in neurology and manages patients with neuromuscular disorders

EF: none known.

BR: none known. BR is a specialist in Physical Medicine and Rehabilitation and manages patients with neurological disorders, including motor neuron disease.

LZ: declares consultancy fees from Amylyx, Biogen Idec, and Mitsubishi Tanabe Pharma America, Inc.

Figures

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Study flow diagram.
See this image and copyright information in PMC

Update of

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