3706 Percutaneous endoscopic gastrostomy in atypical Parkinsonian syndromes: survival and aspiration risk in an international cohort

Abstract Introduction Dysphagia frequently occurs in movement disorders, leading to malnutrition and aspiration. Percutaneous endoscopic gastrostomy (PEG) provides nutrition directly into the stomach, bypassing the dysfunctional swallow. However, PEG insertion is a complex decision, both clinically and ethically. Although PEG outcomes have been reported in other neurological disorders, there is limited research in atypical Parkinsonian syndromes such as Multiple Systems Atrophy (MSA), Progressive Supranuclear Palsy (PSP), and Corticobasal Degeneration (CBD). Insertion rates for these disorders remain variable, reflecting the paucity of research and lack of consistent guidelines. Basic mortality and morbidity data would help inform practice. To our knowledge, this is the first international study to assess whether PEG insertion improves survival and reduces aspiration pneumonia in atypical Parkinsonism. Method International retrospective study of 72 patients with MSA, PSP or CBD. Survival was recorded from reported onset of dysphagia to death. Secondary outcomes included hospital admission rate for aspiration pneumonia. Results Mean survival for the PEG group (n = 12) was 45.5 months (95% CI 34.6–56.4), compared to 20.8 months (95% CI 16.8–25.1) in the non-PEG group (n = 60). From the onset of dysphagia, the mean hospital admission rate for aspiration pneumonia was almost identical (PEG: 0.064/month, non-PEG: 0.062/month). However, within the PEG group, admissions for aspiration pneumonia increased following PEG insertion (0.054 to 0.145/month). Conclusion PEG insertion may improve survival in atypical Parkinsonism, though we found no evidence of reduced aspiration risk. Given the rarity of these conditions, international registries may help to determine the safety and efficacy of PEG use.