Percutaneous endoscopic gastrostomy insertion in patients with neuromuscular disease-a single centre experience of a novel technique.

Background: Neuromuscular diseases (NMD) are often complicated by bulbar dysfunction limiting nutritional intake, and ventilatory failure requiring non-invasive ventilation (NIV). Although nutritional difficulties can be overcome with gastrostomy insertion, this has its own challenges since percutaneous endoscopic gastrostomy (PEG) requires endoscope access via the oral cavity with air leak-associated risk of hypoventilation and respiratory complications in patients with NIV-dependent NMD. Developing a mechanism for PEGs under sedation with concurrent NIV use has remained a clinical challenge. Aim: We report a change in practice in our hospital with the introduction of the endoscopy elbow (EE), an adjunct device enabling simultaneous use of NIV during PEG with minimal air leak. Methods: This retrospective service evaluation analysed data of PEGs in NIV-dependent NMD in a tertiary referral hospital over a ten-year period measuring respiratory complications, critical care admissions, time from referral to procedure, hospital stay, and survival times. Results: The EE enabled a successful transition from PEGs conducted under general anaesthesia to PEGs with sedation and NIV in the endoscopy suite, with statistically significant reduction in respiratory complications and critical care admissions for all patients with NMD and improved six-month survival in patients with motor neurone disease. There was no improvement in length of time from referral to procedure, nor hospital stay. Conclusions: The EE provides a novel technique with improved outcomes for respiratory complications and critical care admissions. This technique may be applicable to other centres caring for similar patient cohorts, although local protocols and resources should be considered.