Comparison of two percutaneous radiological gastrostomy tubes in the nutritional management of ALS patients

Abstract

Patient care and minimizing complications post gastrostomy have to date received little attention in ALS patients. We compare the complications associated with pigtail and mushroom type percutaneous radiological gastrostomy tubes in this patient group. Patients requiring PRG received either Wills-Oglesby or the skin level Entristar. Retrospective review of the clinical notes was performed capturing demographic data, peristomal infection, tube displacement, tube failure, nutritional status, site of disease onset, and survival. Thirty-five patients (Group 1) had the Wills-Oglesby tube of which 14 (40%) tubes required replacement. The Entristar tube was inserted in 29 patients (Group 2) where 8 (28%) required replacement (NS). The incidence of infection was significantly lower with the Entristar tube, (p<0.001). The mean time to tube removal in Group 2 was 223 days (SD 147; range 71-494 days) due to 'buried bumper syndrome'. We conclude that the Entristar skin level gastrostomy tube is associated with a reduction in peristomal infection, tube failure and blockage compared with the Wills-Oglesby tube.

Mushroom-cage gastrostomy tube placement in patients with amyotrophic lateral sclerosis: a 5-year experience in 104 patients in a single institution

“…Two patients (23 and 39) developed complications following replacement tube positioning at the primary gastrostomy insertion site, superficial peri-stomal infections and transient hypoxia selection. Nutrition may be managed in the short life expectancy with naso-gastric feeding, although predicting survival is difficult [17]. The reasons for our technical success and low complication rate are likely to be multifactorial.…”

“…We recorded a tube replacement rate of 19.2% (20/104) similar to the 16% recorded in a large series of 500 patients [31], where replacement was largely a consequence of tube blockage or dislodgement. We recorded no tube blockage or dislodgement, indicating the superior technical aspects of a mushroom-cage device in comparison to other types of radiological gastrostomy tubes [17]. If valve leakage alone is considered as tube malfunction, the tube replacement rate falls to 6.7% (7/104).…”

“…A recently developed mushroom-cage skin level gastrostomy tube (Entristar®, Tyco Healthcare, Mansfield, MA) has several advantages, most importantly the retention bolsters, both internal and skin-levels make it less susceptible to movement across the tract. Extension sets for feeding and flushing prevent tube blockage [17]. This mushroom-cage tube can be used as a replacement in the presence of an existing tract [9].…”

A risk stratifying tool to facilitate safe late-stage percutaneous endoscopic gastrostomy in ALS

“…RIG involves significant discomfort to the patient, so that sedation and high levels of analgesia are routine, with the same concern over exacerbating respiratory failure as with PEG (10,15). Complications such as tube displacement requiring reinsertion or site infection are much more common with RIG (14,16). …”

Palliative care of patients with motor neurone disease

“…If the forced vital capacity (FVC) is less than 50% predicted, it is safer to fit a percutaneous radiological gastrostomy (PRG), which can be fitted without sedation and with the patient sitting upright, and with non-invasive ventilation if necessary (22). The effectiveness and postprocedure survival is similar to that with a PEG, but for both patient groups it is clear that survival is improved if there is normal overnight oximetry (23).…”