PEG Timing in MND — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CarePEG Timing in MNDSCE Palliative Medicine

A 58-year-old man with advanced motor neurone disease has decided to accept gastrostomy (PEG) insertion for nutritional support. When should the PEG ideally be placed?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Early—while FVC is still >50% predicted and nutritional status is maintained

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · E = shown as D · B = shown as E

According to NICE (NG42), gastrostomy should be discussed early and done without delay, explaining benefits of early placement and risks of late insertion including respiratory compromise and mortality. UK specialist MND practice (eg, Oxford) specifies that PEG is safest when FVC is at least 50% predicted — once FVC falls below this, procedural risks rise and RIG may be considered instead. Waiting for BMI < 15 (A), complete dysphagia (C) or FVC < 30% (D) implies late intervention with higher risk. Option E is incorrect: PEG is standard supportive care in MND where indicated.

Reference: NICE NG42, section 1.11.6–1.11.8 (2016, updated 2019) & Oxford University Hospitals Guide to PEG/RIG (current), https://www.ouh.nhs.uk/services/departments/neurosciences/neurology/mnd/support/peg-rig/