Gastrostomy tube placement by endoscopy versus radiologic methods in patients with ALS: A retrospective study of complications and outcome

Abstract

Gastrostomy tube placement for malnutrition and weight loss stabilization occurs in many patients with ALS. We sought to compare the outcome and complications of gastrostomy tube placement by endoscopic (PEG) and multiple radiologic (RIG) methods in ALS patients. A retrospective analysis was conducted on all ALS patients evaluated at Northwestern University who received gastrostomy tubes between January 2009 and March 2012. One hundred and eight gastrostomy tube attempts were made on a total of 100 different patients. Failed gastrostomy tube placement occurred in 15.7% of PEGs and 1.9% of RIGs. Post-procedure aspiration was recognized after 10.5% PEG and 0 RIG attempts. Multivariate analysis revealed a linear increase in risk of post-procedure aspiration for every increase in ALSFRS swallow score. No statistically significant differences in failure or complications were observed when comparing two different methods of RIG (push-type vs. pull-type). Our findings support gastrostomy tube placement by radiographic methods in ALS patients. Gastrostomy tube placement by RIG was more often successful and less often associated with aspiration. Our findings add to the growing body of literature that argues for early gastrostomy tube placement in young patients with prominent bulbar involvement.

Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates

“…Indeed, the low levels of intravenous sedation that are likely to be given by endoscopists to patients that have been identified as high risk most likely serve only to increase the risks but not to lessen the discomfort of standard PEG placement. Allen et al 18 noted a 10.5% procedural aspiration rate at PEG placement compared with only 1/67 patients in this study following nuPEG insertion. In the PROGAS (prospective gastrostomy) study,19 16% of patients with MND receiving PEGs experienced significant distress during the procedure despite using intravenous sedation.…”

“…Failure rates for PEG insertion are higher in neurodegenerative conditions than for other indications—failure occurred in 6% of patients in PROGAS,19 but 16% of attempted PEG placements in another study 18. We identified intrathoracic stomach displacement as the reason for failure in all but one of our patients and hypothesise that this relates to significant diaphragmatic weakness due to the late stage of disease at which the PEG placement occurred.…”

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

“…Initial screening of the titles and abstracts resulted in the exclusion of 414 citations, and full texts of the remaining 31 citations were reviewed in detail 891617181920212223242526272829303132333435363738394041424344. An additional 16 citations were excluded after reviewing the full articles, for the following reasons: duplicated reports,424344 noncomparative studies,37 studies with RIG placement after failure of PEG,2535 no data present on 30-day mortality,294041 no reported case of 30-day mortality,192730343638 and review articles 1721. Fifteen published studies including two RCTs1639 and 13 NRCTs891920222324262831323342 were included in the final analysis.…”

“…An additional 16 citations were excluded after reviewing the full articles, for the following reasons: duplicated reports,424344 noncomparative studies,37 studies with RIG placement after failure of PEG,2535 no data present on 30-day mortality,294041 no reported case of 30-day mortality,192730343638 and review articles 1721. Fifteen published studies including two RCTs1639 and 13 NRCTs891920222324262831323342 were included in the final analysis.…”

“…A total of five studies919222432 were performed in patients with motor neuron disease. Pooled analysis of the ORs showed no significant difference in 30-day mortality between the PEG group and RIG group (OR, 0.84; 95% CI, 0.43-1.69; P =0.637) (Fig.…”