Dysphagia Assessments as Criteria in the 'Decision-Making Process' for Percutaneous Endoscopic Gastrostomy Placement in People with Amyotrophic Lateral Sclerosis: A Systematic Review.
Ermioni Kotsia, Elizabeth Chroni, Anna Alexandropoulou and 4 others
PMID 38517530WHAT IT FOUND
Dysphagia is a common trigger for PEG placement in ALS, but the tools used to measure it vary widely across studies.
There is no single agreed-upon assessment or threshold. Clinicians must rely on multidisciplinary judgment rather than a specific test score to decide when to insert a feeding tube.
Key findings
01The criteria for PEG insertion varied significantly: five studies relied solely on swallowing difficulties, while others combined weight loss, respiratory function, or neurological exams.
02There is high heterogeneity in the dysphagia assessment tools used, with no consensus on which instrument or cut-off score should guide the decision for PEG placement.
03The evidence base for these decisions is weak, with all included studies rated as having moderate to high risk of bias and low levels of evidence.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The included studies had low levels of evidence and high risk of bias. There was significant heterogeneity in study designs, populations, and assessment tools, making direct comparison difficult. Many studies did not explicitly state if an SLT was part of the multidisciplinary team, though it was assumed based on methodology. The review did not determine which assessment method is superior, only that methods vary widely.
Declared interests
The study was funded by the University of Patras. No other conflicts of interest were reported.
The easy way to misread this
Do not assume that a specific score on a dysphagia test (like EAT-10 or ALSFRS-R) automatically mandates PEG insertion. The review found no consensus on cut-offs, and decisions in the included studies often depended on multiple factors like weight loss and respiratory function, not just swallowing test results.