Amyotrophic lateral sclerosis (ALS) is a rapidly progressing degenerative motor neuron disease that leads to significant muscle weakness. Patients can present with severe dysphagia and require nutritional support. While percutaneous endoscopic gastrostomy (PEG) is a standard procedure for these patients, its effect on survival is not yet clear. Therefore, we aimed to evaluate the impact of PEG placement on ALS patients survival.

We retrospectively reviewed health records of ALS patients followed at a Neurological Department in the northeast region of Portugal for the 2005–2016 period. Potentially relevant clinical information was collected for survival analysis using Kaplan–Meier estimator and Mantel–Cox regression.

In the studied period, 75 incident ALS cases were identified. Information regarding symptom onset was available for 62 (83%) patients, and PEG was placed after informed consent in 27 (36%) patients. The overall median survival from symptom onset was 1142 (95% CI: 866–1418) days and did not differ between PEG and non-PEG groups (Fig. 1). In the PEG group (n=27), 19 (70%) died by the end of the follow-up period. Overall median survival post-PEG placement was 320 (95% CI: 135–505) days. Bulbar ALS cases (n=18) had a median survival of 249 days while the remaining 9 Spinal cases had a median survival of 709 days (Fig. 2). Both LogRank test and Mantel–Cox regression using ALS subtype as covariate did not yield significant results regarding post-PEG survival (P=0.312; HR=0.566 [95% CI: 0.185–1.730], P=0.566; respectively).

In conclusion, PEG did not impact ALS survival in our study. Post-PEG survival was also similar in both bulbar- and spinal-onset groups. However, our analysis is limited by the small sample size. Studies with more participants are required to more effectively estimate the impact of PEG in overall and subgroups ALS survival.