Clémence Marois1, Maria Del Mar Amador2, Christine Payan3, Lucette Lacomblez4, Anne-Marie Bonnet5, Bertrand Degos6, Jean-Christophe Corvol7, Marie Vidailhet8, Nadine Le Forestier9, Valérie Mesnage10, David Grabli11. 1. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France. Electronic address: clemence.marois@aphp.fr. 2. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France. Electronic address: mariadelmar.amador@aphp.fr. 3. Assistance Publique Hôpitaux de Paris, Service de Pharmacologie Clinique, Hôpital Pitié-Salpêtrière, F-75013 Paris, France. Electronic address: christine.payan@aphp.fr. 4. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Assistance Publique Hôpitaux de Paris, Service de Pharmacologie Clinique, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Sorbonne Université, Université Pierre et Marie Curie Paris 06 UMR S 1127, F-75013 Paris, France; Institut National de Santé et en Recherche Médicale U 1127 and Centre d'Investigation Clinique 1422, F-75013 Paris, France; Centre National de Recherche Scientifique U 7225, F-75013 Paris, France; Institut du Cerveau et de la Moelle Epinière, F-75013 Paris, France. Electronic address: lucette.lacomblez@aphp.fr. 5. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France. Electronic address: anne-marie.bonnet@aphp.fr. 6. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France. Electronic address: bertrand.degos@aphp.fr. 7. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Sorbonne Université, Université Pierre et Marie Curie Paris 06 UMR S 1127, F-75013 Paris, France; Institut National de Santé et en Recherche Médicale U 1127 and Centre d'Investigation Clinique 1422, F-75013 Paris, France; Centre National de Recherche Scientifique U 7225, F-75013 Paris, France; Institut du Cerveau et de la Moelle Epinière, F-75013 Paris, France. Electronic address: jean-christophe.corvol@aphp.fr. 8. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Sorbonne Université, Université Pierre et Marie Curie Paris 06 UMR S 1127, F-75013 Paris, France; Institut National de Santé et en Recherche Médicale U 1127 and Centre d'Investigation Clinique 1422, F-75013 Paris, France; Centre National de Recherche Scientifique U 7225, F-75013 Paris, France; Institut du Cerveau et de la Moelle Epinière, F-75013 Paris, France. Electronic address: marie.vidailhet@aphp.fr. 9. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Université Paris Sud, Département de Recherche en Ethique ES3, F-91400 Orsay, France. Electronic address: nadine.leforestier@aphp.fr. 10. Assistance Publique Hôpitaux de Paris, Service de Neurologie, Hôpital Saint-Antoine, Paris, France. Electronic address: valerie.mesnage@aphp.fr. 11. Assistance Publique Hôpitaux de Paris, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Institut National de Santé et en Recherche Médicale U 1127 and Centre d'Investigation Clinique 1422, F-75013 Paris, France; Centre National de Recherche Scientifique U 7225, F-75013 Paris, France; Institut du Cerveau et de la Moelle Epinière, F-75013 Paris, France. Electronic address: david.grabli@aphp.fr.
Abstract
OBJECTIVE: To investigate the indications and the outcomes of gastrostomy tube insertion in patients with parkinsonian syndromes. METHODS: Consecutive patients with Parkinson's disease or atypical parkinsonism, seen in two French tertiary referral movement disorders centers, that received gastrostomy tube insertion (GTI) for feeding between 2008 and 2014 were included in this retrospective study. Data regarding clinical status, indications and outcomes were retrieved from medical files. The main outcome measure was survival duration following gastrostomy insertion according to Kaplan-Meier estimate. Cox analysis was also performed to identify factors associated with survival. Finally, we described short term and long term adverse effects occurring during the follow-up period. RESULTS: We identified 33 patients with Parkinsonism that received GTI during the study period. One patient was excluded from the analysis because of missing data. Among 32 patients, 7 (22%) had Parkinson's disease and 25 (78%) had atypical parkinsonism. The median survival following the procedure was 186 days (CI 95% [62-309]). In Cox model analysis, total dependency was the only factor negatively associated with survival (HR 0.1; 95% CI [0.02-0.4], p = 0.001). Pneumonia was the most frequent adverse event. CONCLUSION: In this sample of patients with parkinsonian syndromes, survival after GTI was short particularly in totally dependent subjects. Aspiration pneumonia was not prevented by GTI. A larger prospective study is warranted to assess the potential benefits of gastrostomy, in order to identify the most appropriate indications and timing for the procedure.
OBJECTIVE: To investigate the indications and the outcomes of gastrostomy tube insertion in patients with parkinsonian syndromes. METHODS: Consecutive patients with Parkinson's disease or atypical parkinsonism, seen in two French tertiary referral movement disorders centers, that received gastrostomy tube insertion (GTI) for feeding between 2008 and 2014 were included in this retrospective study. Data regarding clinical status, indications and outcomes were retrieved from medical files. The main outcome measure was survival duration following gastrostomy insertion according to Kaplan-Meier estimate. Cox analysis was also performed to identify factors associated with survival. Finally, we described short term and long term adverse effects occurring during the follow-up period. RESULTS: We identified 33 patients with Parkinsonism that received GTI during the study period. One patient was excluded from the analysis because of missing data. Among 32 patients, 7 (22%) had Parkinson's disease and 25 (78%) had atypical parkinsonism. The median survival following the procedure was 186 days (CI 95% [62-309]). In Cox model analysis, total dependency was the only factor negatively associated with survival (HR 0.1; 95% CI [0.02-0.4], p = 0.001). Pneumonia was the most frequent adverse event. CONCLUSION: In this sample of patients with parkinsonian syndromes, survival after GTI was short particularly in totally dependent subjects. Aspiration pneumonia was not prevented by GTI. A larger prospective study is warranted to assess the potential benefits of gastrostomy, in order to identify the most appropriate indications and timing for the procedure.
Authors: Duk Soo Kim; Zachary J Kunicki; Oliver W Philips; Richard N Jones; Joseph H Friedman; Benzi Kluger; Umer Akbar Journal: Parkinsonism Relat Disord Date: 2021-08-26 Impact factor: 4.402
Authors: Duk Soo Kim; Richard N Jones; Theresa I Shireman; Benzi M Kluger; Joseph H Friedman; Umer Akbar Journal: Clin Park Relat Disord Date: 2020-12-23