Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS.
BACKGROUND
Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion.


OBJECTIVE
To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure.


METHODS
25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) <50% underwent PRG after October 2000. They were compared with 25 consecutive ALS patients with FVC <50% who underwent PEG before October 2000. Respiratory function was evaluated before and after the procedure.


RESULTS
The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (p<0.004). Respiratory function decreased more in the PEG group than in the PRG group (p<0.02).


CONCLUSIONS
PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.
Chiò
A
A
Second Division of Neurology, Department of Neuroscience, University of Turin, via Cherasco 15, 10126 Turin, Italy. achio@usa.net
Galletti
R
R
Finocchiaro
C
C
Righi
D
D
Ruffino
M A
MA
Calvo
A
A
Di Vito
N
N
Ghiglione
P
P
Terreni
A A
AA
Mutani
R
R
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000628:therapy; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011029:Pneumoradiography / Q000379:methods*; D011677:Punctures; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology