LETTER TO THE EDITORS Nutritional support by ‘‘conventional’’ percutaneous endoscopic gastrostomy feeding may not result in weight gain in Parkinson’s disease Yuu Yamazaki • Keitaro Kobatake • Mutsuhiro Hara • Makoto Katagiri • Masayasu Matsumoto Received: 26 December 2010 / Revised: 10 February 2011 / Accepted: 21 February 2011 / Published online: 10 March 2011 Ó Springer-Verlag 2011 Dear Sirs, Percutaneous endoscopic gastrostomy (PEG) is being increasingly used in patients with neurogenic dysphagia [4–7] to improve their nutrition. However, only sparse information is available on the use of PEG for long-term feeding in patients with chronic neurological disorders including Parkinson’s disease (PD). Here, we carried out a study to evaluate changes in the body weight of PD patients with neurogenic dysphagia before and after PEG. All patients who underwent the ‘‘pull’’ method of 20–22 Fr PEG at Kobatake Hospital from 1996–2009 were eli- gible for inclusion in the study. Inclusion criteria were the availability of complete weight and height data in the medical records for the study period and successful PEG. Body weight was recorded at 6 and 12 months pre-opera- tively, at baseline, and at 3, 6, 9, and 12 months following PEG. After PEG, an appropriate formula and feeding reg- imen was determined by the nutrition support team (NST). Body weight on the morning of the PEG procedure was used as the baseline index weight for comparison to the pre- and post-operative values. Comparisons of mean weights between time points were analyzed by the paired Student’s t test (Microsoft Excel 2010, Redmond, WA). During the study period, 8 subjects (5male, 3 female) met the inclusion criteria. The average age of the subjects was 79 years. Other clinical characteristics are shown in Table 1. Overall, the average weight loss over 12 months pre- operatively was 8 kg (P \ 0.03), whereas the average weight loss over 12 months after PEG was 3 kg, which did not reach statistical significance (Fig. 1a). Body weight changes by gender are outlined in Fig. 1b and c. Both males and females showed significant weight loss over 12 months pre-operatively, with an average loss of 9 and 5 kg, respectively (P \ 0.03, Fig. 1b, c). Interestingly, while males lost an average of 6 kg in the 12 month post- operative period (P \ 0.05), females had an average weight gain of 3 kg, which did not reach statistical sig- nificance (P = 0.11). The results of our study suggest that, despite the appropriate formula and feeding regimen as determined by the NST (25–30 kcal/kg for a bedridden patient), this ‘‘conventional’’ PEG feeding may not result in weight gain in PD. On the other hand, Britton et al. [4] examined 32 younger patients with chronic neurological disorders and showed that PEG was an effective method for feeding, with all patients having weight gain and an improvement in their quality of life. Given that weight loss is one of the indications for PEG feeding [5], the fact that weight changes after PEG may vary according to age or disorder should be taken into account by neurologists in their management of patients who require PEG feeding. The reason for the post-operative weight loss in male PD patients is unclear. As our patients were all bedridden and the required calories and nutrients were administered by PEG feeding, it seems unlikely that decreased energy Y. Yamazaki (&) Á M. Matsumoto Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan e-mail: yyamazak@hiroshima-u.ac.jp K. Kobatake Department of Neurology, Kobatake Hospital, Fukuyama, Japan M. Hara Department of Internal Medicine, Kobatake Hospital, Fukuyama, Japan M. Katagiri Department of Surgery, Kobatake Hospital, Fukuyama, Japan 123 J Neurol (2011) 258:1561–1563 DOI 10.1007/s00415-011-5971-7