Gastrostomy in amyotrophic lateral sclerosis: effects of non-invasive ventilation

1152 www.thelancet.com/neurology Vol 14 December 2015 aff ecting patient survival during the post-procedure period. Improved survival is a well established benefi t of non-invasive ventilation in patients with amyotrophic lateral sclerosis, both when initiation of this ventilation is late (hypercapnia and forced vital capacity 38–45% of predicted at initiation) and when it is early (forced vital capacity 49–56% of predicted at initiation, which was probably the case in the per-oral image-guided gastrostomy group). In our opinion, failure to include non-invasive ventilation in the regression model could have led to a misidentifi cation of predictors of post-procedure survival. To conclude, our opinion is that, in view of its important and established positive eff ects on patient survival and wellbeing, non-invasive ventilation should be a key consideration when gastrostomy insertion in patients with amyotrophic lateral sclerosis is being assessed.