预防性经皮胃造瘘对口腔癌切除并同期修复重建术后术区感染影响的研究

目的:探究不同肠内营养方式对口腔癌根治性切除术并同期行修复重建术后术区感染的影响。方法:回顾性分析2018年1月~2023年1月就诊于新疆医科大学第一附属医院口腔颌面肿瘤外科接受口腔癌根治性切除术并同期行修复重建的患者的临床资料,根据给予的不同肠内营养方式,将纳入病例分为预防性经皮胃造瘘组(n=26)、鼻饲管组(n=54)及经口进食组(n=33)。比较3组患者手术治疗后术区感染率、皮瓣坏死率情况。结果:预防性经皮胃造瘘组患者术区感染率显著低于鼻饲管组和经口进食组(P<0.05);3组间皮瓣坏死率比较差异无统计学意义(P>0.05)。术后6周患者体重指数、总蛋白、白蛋白、肌酐、红细胞压积值与入院时测量的差值在3组间比较存在明显差异(P<0.01)。结论:预防性经皮胃造瘘可以有效降低口腔癌根治性切除术并同期行修复重建术后皮瓣感染率,值得临床推广。

内镜下治疗未分化型早期胃癌的临床研究

目的:探讨未分化型早期胃癌淋巴结转移的危险因素,从而对未分化型早期胃癌患者行内镜下治疗提供理论依据。方法:回顾性分析河北医科大学附属邢台市人民医院肿瘤外科1996年1月至2008年12月90例未分化型早期胃癌的临床病理资料,按照临床病理特征与淋巴结转移的关系进行统计学分析。结果:通过多因素分析,肿瘤大小>2 cm,淋巴管癌栓和黏膜下癌对淋巴结转移的差异具有统计学意义(P<0.05)。无危险因素的患者,淋巴结转移率为0;3个危险因素均有者,淋巴结转移率高达57.1%。结论:肿瘤大小>2 cm,存在淋巴管癌栓和黏膜下癌是未分化型早期胃癌淋巴结转移的独立危险因素。对于无危险因素的患者,行内镜下切除是可行的。

无疤痕经脐单孔腹腔镜胆囊切除术

目的探讨经脐入路无疤痕单孔腹腔镜胆囊切除术的可行性及应用价值。方法回顾分析15例患者行经脐单孔腹腔镜胆囊切除术的临床资料。结果 15例手术均采用经脐单孔腹腔镜法完成。手术时间35～80min,平均(45±5)min。术后1～3d出院,无并发症发生,患者疼痛轻,恢复快,切口愈合后无明显疤痕。结论经脐入路单孔腹腔镜胆囊切除术安全可行,并可达到体表"无疤痕"的美容效果。

ERCP、EST联合LC治疗胆囊结石合并胆总管结石的临床分析

目的:探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并胆总管结石的临床疗效。方法:回顾分析2009年7月至2013年7月为145例胆囊结石合并胆总管结石患者行ERCP+EST+LC/腹腔镜胆总管探查术的临床资料,其中138例LC术前发现合并胆总管结石,先行ERCP+EST,根据EST术后并发症治愈情况再行LC;LC术后发现胆总管残余结石7例,于LC术后1周行ERCP+EST治疗。结果:术前发现合并胆总管结石的138例患者中,129例LC术前取石成功,胆总管结石完全排出,成功率93.5%,ERCP+EST术后出现胰腺炎或高淀粉酶血症11例,胆管炎1例,消化道出血1例,治疗痊愈后行LC。另有9例ERCP插管不成功后行开腹胆囊切除+胆总管探查T管引流术。LC术后发现胆总管残余结石7例,ERCP+EST取石均成功,无并发症发生。结论:ERCP+EST联合LC治疗胆囊结石合并胆总管结石具有创伤小、效果好、并发症少、康复快等优点,扩大了LC的指征,符合外科手术微创化的趋势,可在临床推广应用。

内镜黏膜下隧道法切除早期食管癌及癌前病变的应用分析

目的 探讨内镜黏膜下隧道法在切除早期食管癌及癌前病变中的应用价值.方法 17例术前超声内镜检查判断病变局限于黏膜层,经黏膜活检发现食管上皮局灶癌变或重度不典型增生的患者,采用黏膜下隧道法的内镜下早期癌切除.结果 17例中,术后病理确诊鳞状上皮增生伴黏膜慢性炎4例,重度不典型增生5例,高至中分化鳞癌8例,其中T1a期7例,T1b期1例.有2例切除黏膜边缘重度不典型增生,1例黏膜下层切缘见癌细胞,其余病例均病灶完整切除.术后1例患者因迟发性出血转开胸手术治疗,其余患者均恢复良好.结论 黏膜下隧道法切除黏膜内早期食管癌及癌前病变安全、有效,更符合直视、充分暴露的外科原则,明显减少出血、穿孔的并发症风险,但其对病灶切除范围判断有一定困难,需在手术中充分注意.

经皮椎间孔镜手术对不同椎间孔镜下分型腰椎间盘突出症的疗效分析

目的:探讨经皮椎间孔镜技术治疗不同椎间孔镜下分型腰椎间盘突出症的手术疗效。方法:对128例行经皮椎间孔镜手术的腰椎间盘突出症患者进行椎间孔镜镜下分型,共分为4种:压迫型、瘢痕型、钙化型、侧隐窝狭窄型;并采用视觉模拟评分法(visual analog scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科协会评估治疗分数(Japanese Orthopaedic Association Scores,JOA)及Mac Nab标准评估手术疗效。结果:经过平均(10.5±3.7)个月的随访,各分型患者腰腿痛VAS评分、ODI评分较术前均明显减低,JOA评分较术前明显升高,MacNab标准评定疗效优良率95.31%,VAS、ODI、JOA差异均有统计学意义(P<0.05)。结论:经皮椎间孔镜技术对不同椎间孔镜下分型腰椎间盘突出症均有显著疗效,合理利用该分型可以使该手术最大程度地缓解患者的症状,有效提高手术疗效,显著减少术后复发率。

十二指肠乳头旁憩室与胆总管结石及胆囊切除术后综合征的关系

目的探讨十二指肠乳头旁憩室(JPD)与胆总管结石及胆囊切除术后综合征(PCS)的关系。方法回顾分析313例患者经内镜逆行胰胆管造影(ERCP)资料,计算JPD的检出率;比较两组(憩室组和非憩室组)胆总管结石的发生率及60岁以上患者占有比例;分析114例胆囊切除术后患者ERCP造影结果。结果全组JPD检出率26.5%;憩室组胆总管结石的发生率显著高于非憩室组(82.9%vs56.1%,P<0.01),憩室组60岁以上者比例高于非憩室组(61.4%vs43.9%,P<0.05);114例胆囊切除术后患者ERCP造影显示胆总管结石的发生率80.4%,JPD合并发生率31.5%。结论随着年龄的增长,十二指肠乳头旁憩室的发生率增加,十二指肠乳头旁憩室是胆总管结石形成的重要危险因素,胆总管结石和十二指肠乳头旁憩室是胆囊切除术后综合征的两大主要原因。

Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis

AIM: To compare endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) for early gastric cancer(EGC).METHODS: Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Schol-ar and Cochrane library databases. Quality of each included study was assessed according to current Co-chrane guidelines. Primary endpoints were en bloc re-section rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and re-currence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects mod-els(in case of low heterogeneity) or DerSimonian and Laird test for random-effects models(in case of high heterogeneity).RESULTS: Ten retrospective studies(8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR(stan-dardized mean difference 1.73, 95%CI: 0.52-2.95, P =0.005) and the "en bloc " and histological complete re-section rates were significantly higher in the ESD group [OR = 9.69(95%CI: 7.74-12.13), P < 0.001 and OR = 5.66,(95%CI: 2.92-10.96), P < 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09,(95%CI: 0.05-0.17), P < 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67,(95%CI, 2.77-7.87), P < 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49(0.6-3.71), P = 0.39].CONCLUSION: In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR.

原发于胃肠道的黏膜相关淋巴组织淋巴瘤及弥漫性大B细胞淋巴瘤临床表现及内镜特征的比较

目的:回顾性分析原发于胃肠道的黏膜相关淋巴组织淋巴瘤(mucosa-associated lymphoid tissue lymphoma,MALT淋巴瘤)和弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)两种类型淋巴瘤的临床表现、内镜特征,探讨其确诊方式的差异。方法:对2009年1月—2016年7月经病理学证实的119例原发于胃肠道的MALT淋巴瘤和DLBCL患者资料进行回顾性分析。结果:119例患者中MALT淋巴瘤男女比为1.73∶1,DLBCL男女比≈1。两组发病中位年龄均为55岁。MALT淋巴瘤与DLBCL均主要累及胃部,前者以胃体多见,后者以胃窦多见。临床表现均以腹部不适为主,其次为体重减轻、消化道出血等。内镜下确诊率为74.8%。MALT淋巴瘤患者仅通过内镜下黏膜剥离切除术/内镜下黏膜整片切除术(EMR/ESD)确诊病例明显多于DLBCL患者(P=0.006),其余方式均无统计学差异(P>0.05)。内镜下常见表现:溃疡型、黏膜隆起型、浅表型、肿块或息肉样型,两组均以溃疡型最多见。MALT淋巴瘤患者中Ⅰ~Ⅱ期占73.2%,DLBCL患者中Ⅰ~Ⅱ期占42.3%,两组间差异具有统计学意义(P=0.001)。DLBCL患者中乳酸脱氢酶(LDH)高水平者明显多于MALT淋巴瘤(P=0.002)。幽门螺杆菌总体检测率为63.0%,MALT淋巴瘤阳性率为53.1%,DLBCL阳性率为46.5%。结论:MALT淋巴瘤和DLBCL临床表现多样,内镜确诊率高,内镜确诊方式为组织活检、大块组织EMR或ESD,内镜下病变形态以溃疡型最多见。MALT淋巴瘤患者通过EMR/ESD确诊病例明显多于DLBCL患者,且临床分期MALT淋巴瘤多为早期,DLBCL多为晚期。而DLBCL患者中高水平LDH的多于MALT淋巴瘤。

平息丹对脾虚湿阻证结肠息肉经内镜切除术后患者临床疗效及相关血清指标的影响

目的评价平息丹对脾虚湿阻证结肠息肉经内镜切除术后的患者临床疗效及相关血清指标的影响。方法将112例脾虚湿阻证结肠息肉并经内镜切除术后患者随机分为治疗组和对照组,每组56例。治疗组经内镜息肉切除术后予用平息丹口服3个月,对照组不予任何药物治疗。比较两组中医症状疗效、治疗前后甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、胃泌素17(G-17)、息肉复发率及不良事件。结果治疗组各中医症状有效率及总有效率均显著高于对照组(P<0.05)。治疗后治疗组血清TG、TC、LDL-C水平均下降(P<0.05),HDL-C水平上升(P<0.05)。治疗后治疗组G-17明显降低(P<0.05),且与对照组同期比较差异有统计学意义(P<0.05)。治疗组息肉复发率为11.32%,明显低于对照组的36.36%(P<0.05)。治疗期间治疗组未出现明显不良反应。结论平息丹治疗能够明显改善脾虚湿阻证结肠息肉经内镜切除术后患者中医症状,降低患者血清TG、TC、LDL-C、G-17水平,提高HDL-C水平,降低结肠息肉复发率,且安全性好。

Long-term follow up of endoscopic resection for type 3 gastric NET

AIM:To clarify the short and long-term results and to prove the usefulness of endoscopic resection in type 3gastric neuroendocrine tumors(NETs).METHODS:Of the 119 type 3 gastric NETs diagnosed from January 1996 to September 2011,50 patients treated with endoscopic resection were enrolled in this study.For endoscopic resection,endoscopic mucosal resection(EMR)or endoscopic submucosal dissection(ESD)was used.Therapeutic efficacy,complications,and follow-up results were evaluated retrospectively.RESULTS:EMR was performed in 41 cases and ESD in 9 cases.Pathologically complete resection was performed in 40 cases(80.0%)and incomplete resection specimens were observed in 10 cases(7 vs 3 patients in the EMR vs ESD group,P=0.249).Upon analysis of the incomplete resection group,lateral or vertical margin invasion was found in six cases(14.6%)in the EMR group and in one case in the ESD group(11.1%).Lymphovascular invasions were observed in two cases(22.2%)in the ESD group and in one case(2.4%)in the EMR group(P=0.080).During the follow-up period(43.73;13-60 mo),there was no evidence of tumor recurrence in either the pathologically complete resection group or the incomplete resection group.No recurrence was reported during follow-up.In addition,no mortality was reported in either the complete resection group or the incomplete resection group for the duration of the follow-up period.CONCLUSION:Less than 2 cm sized confined submucosal layer type 3 gastric NET with no evidence of lymphovascular invasion,endoscopic treatment could be considered at initial treatment.

早期贲门癌内镜下诊断与治疗

贲门癌在我国的发病率呈上升态势,防控形势十分严峻。由于贲门癌早期症状不明显,超过90%的患者就诊时已属中晚期,而中晚期贲门癌患者的5年生存率不足20%。再者,贲门活检取材困难,早期检出率很低,影响了患者接受根治性治疗的可能性和治疗效果。随着人们对自身健康的重视和内镜诊断水平的进步,特别是色素内镜、放大内镜及超声内镜等技术的发展,使早期贲门癌和癌前病变检出率逐渐提高。而且,大部分早期贲门癌在内镜下即可获得根治性治疗,患者5年生存率超过90%。目前,内镜下黏膜切除术(endoscopic mucosal resection,EMR)和内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)已被证实是治疗早期贲门癌安全、有效的内镜下微创治疗技术。本文就早期贲门癌的内镜下诊断与治疗的临床应用及发展现状进行综述。

内镜逆行胰胆管造影治疗取石困难胆总管结石64例

目的:探讨内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)在取石困难胆总管结石中的应用价值.方法:连续收集64例取石困难胆总管结石患者,分析在ERCP术中操作的难点,巨大结石采用机械碎石、激光碎石、体外震波碎石法;胆总管畸形采用变换体位、反复吸引、网篮体外塑形法;胆管过度扩张或狭窄采用吸引或柱状气囊扩张法;结石坚硬采用反复缓慢加压碎石法再进行胆管取石.结果:64例取石困难者,经ERCP取石成功53例,总体取石成功率为82.81%.其中巨大结石者18例,取石成功15例,成功率83.33%;胆总管畸形者18例,取石成功14例,成功率77.78%;胆总管过度扩张或狭窄者19例,取石成功16例,成功率84.21%;结石坚硬者9例,取石成功8例,成功率88.89%.结论:ERCP术可以有效地治疗取石困难胆总管结石.

Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation

AIM:To clarify the strategy for early diagnosis of pancreaticobiliary maljunction(PBM) without biliary dilatation and to pathologically examine gallbladder before cancer develops.METHODS:The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography(ERCP).Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having PBM.Of these,patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary dilatation.The process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively investigated.Histopathological analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was conducted.RESULTS:Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain(n = 16) or jaundice(n = 12).Radical surgery for gallbladder cancer was only possible in 11 patients(31%) and only 4 patients(11%) survived for 5 years.Eight patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography(MRCP).The median age of these 8 patients was younger by a decade than PBM patients with gallbladder cancer.All 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not occurred.Wall thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls,and hyperplastic changes,hypertrophic muscular layer,subserosal fibrosis,and adenomyomatosis were detected in 7(88%),5(63%),7(88%) and 5(63%) patients,respectively.Ki-67 labeling index was high and K-ras mutation was detected in 3 of 6 patients.CONCLUSION:To detect PBM without biliary dilatation before onset of gallbladder cancer,we should perform MRCP for individuals showing increased gallbladder wall thickness on ultrasound.

Congenital left intrahepatic bile duct draining into gastric wall mimicking biliary reflux gastritis

Abnormalities and variations of the biliary ducts are not rare.Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater.However,drainage of the left hepatic bile duct into the stomach is extremely rare.A 29-year old man was admitted to the hospital with the diagnosis of biliary reflux gastritis.Comprehensive imaging modalities were performed including electronic endoscopy,endoscopic ultrasonography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangio-pancreatography.Finally,congenital ectopic left intrahepatic bile duct draining into the stomach was found,which caused biliary reflux gastritis.The patient did not receive any surgery.Good recovery was achieved by medical treatment.

Transanal endoscopic surgery in rectal cancer

Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond(T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentageof infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.

慢性胰腺炎内镜治疗现状

慢性胰腺炎发病率不断攀高,但由于其确切的病因和发病机制尚不清楚,给治疗带来较大困难.近年来,内镜治疗技术的飞速发展,为慢性胰腺炎的治疗提供了新的方向.本文详述慢性胰腺炎内镜治疗的现状和进展,指出存在的问题和困难,对慢性胰腺炎内镜治疗的进一步发展具有指导意义.

Giant choledocholithiasis treated by mechanical lithotripsy using a gastric bezoar basket

Mechanical lithotripsy （ML） is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no es- tablished endoscopic extraction method for such gi- ant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct （CBD）. Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An at- tempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capturethe stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangio- pancreatography; each of which took 30 rain. No com- plications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.

胆管恶性梗阻经内镜支架置入术后胆管炎的危险因素

目的:探讨胆管恶性梗阻患者经内镜支架置入术后发生胆管炎的危险因素.方法:以年龄和性别为匹配条件,对2008-01/2013-12南京医科大学附属苏州医院成功行内镜支架置入术的胆管恶性梗阻患者术后发生胆管炎的40例(C组)及未发生胆管炎的40例(NC组)进行1∶1配对病例对照研究.采用单因素和多因素分析探讨术后胆管炎的可能危险因素.结果:单因素分析结果显示,梗阻部位、支架类型及糖尿病病史在两组间差异有统计学意义;多因素分析结果显示,梗阻部位与术后胆管炎发生显著相关,OR值为8.815,95%CI:1.575-50.009.结论:高位梗阻是经内镜支架置入术后胆管炎的独立危险因素,值得进一步研究.

Nutritional support teams increase percutaneous endoscopic gastrostomy uptake in motor neuron disease

AIM:To examine factors influencing percutaneous endoscopic gastrostomy(PEG) uptake and outcomes in motor neuron disease(MND) in a tertiary care centre.METHODS:Case notes from all patients with a confirmed diagnosis of MND who had attended the clinic at the Repatriation General Hospital between January 2007 and January 2011 and who had since died,were audited.Data were extracted for demographics(age and gender),disease characteristics(date of onset,bulbar or peripheral predominance,complications),date and nature of discussion of gastrostomy insertion,nutritional status [weight measurements,body mass index(BMI)],date of gastrostomy insertion and subsequent progress(duration of survival) and quality of life(QoL) [Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)].In addition,the type of clinician initiating the discussion regarding gastrostomy was recorded as Nutritional Support Team(involved in providing nutrition input viz Gastroenterologist,Speech Pathologist,Dietitian) and other(involved in non-nutritional aspects of patient care).Factors affecting placement and outcomes including length of survival,change in weight and QoL were determined.RESULTS:Case records were available for all 86 patients(49 men,mean age at diagnosis 66.4 years).Thirty-eight patients had bulbar symptoms and 48 had peripheral disease as their presenting feature.Sixty-six patients reported dysphagia.Thirty-one patients had undergone gastrostomy insertion.The major indications for PEG placement were dysphagia and weight loss.Nine patients required immediate full feeding,whereas 17 patients initially used the gastrostomy to supplement oral intake,4 for medication administration and 1 for hydration.Initially the PEG regime met 73% ± 31% of the estimated total energy requirements,increasing to 87% ± 32% prior to death.There was stabilization of weight in patients undergoing gastrostomy [BMI at 3 mo(22.6 ± 2.2 kg/m 2) and 6 mo(22.5 ± 2.0 kg/m 2) after PEG placement compared to weight at the time of the procedure(22.5 ± 3.0 kg/m 2)].However,weight loss recurred in the terminal stages of the illness.There was a strong trend for longer survival from diagnosis among MND in PEG recipients with limb onset presentation compared to similar patients who did not undergo the procedure(P = 0.063).Initial discussions regarding PEG insertion occurred earlier after diagnosis when seen by nutrition support team(NST) clinicians compared to other clinicians.(5.4 ± 7.0 mo vs 11.9 ± 13.4 mo,P = 0.028).There was a significant increase in PEG uptake(56% vs 24%,P = 0.011) if PEG discussions were initiated by the NST staff compared to other clinicians.There was no change in the ALSFRS-R score in patients who underwent PEG(pre 34.1 ± 8.6 vs post 34.8 ± 7.4),although in non-PEG recipients there was a nonsignificant fall in this score(33.7 ± 7.9 vs 31.6 ± 8.8).Four patients died within one month of the procedure,4 developed bacterial site infection requiring antibiotics and 1 required endoscopic therapy for gastric bleeding.Less serious complications attributed to the procedure included persistent gastrostomy site discomfort,poor appetite,altered bowel function and bloating.CONCLUSION:Initial discussion with NST clinicians increases PEG uptake in MND.Gastrostomy stabilizes patient weight but weight loss recurs with advancing disease.