Entristar skin-level gastrostomy tube: primary placement with radiologic guidance in patients with amyotrophic lateral sclerosis.
OBJECTIVE
To retrospectively review the authors' experience with a radiologic method of primary insertion of a skin-level gastrostomy tube (Entristar; Tyco Healthcare, Mansfield, Mass) in patients with amyotrophic lateral sclerosis (ALS).


METHODS
Over a 12-month period (September 2002 through September 2003), 25 patients with ALS (mean age, 62.4 years; age range, 41-83 years; 15 men, 10 women) who had bulbar impairment and a body mass index of less than 20 kg/m(2) or weight loss of greater than 10% were selected for placement of an enteral feeding tube. Patients with overnight oxygen desaturation or respiratory acidosis were referred for placement of the Entristar tube with radiologic guidance. This procedure was performed with local anesthesia and without sedation by using a modified percutaneous lateral fluoroscopic technique that aided tube insertion in patients with elevation of the hemidiaphragm and a "high" stomach position. Technical success and immediate and delayed procedure complications were recorded.


RESULTS
The Entristar tube was successfully inserted in all 25 patients. Pneumoperitoneum as an early complication was documented in one patient, and one patient developed a pelvic abscess that required drainage. Follow-up for a median of 112 days (range, 14-343 days) revealed superficial wound infections in four patients and weight gain in two patients; weight gain necessitated tube replacement in one patient. There were no procedure-related deaths.


CONCLUSIONS
Radiologically guided insertion of the Entristar skin-level gastrostomy tube is a safe procedure in patients with ALS that allows the creation of a permanent feeding gastrostomy without the need for sedation or endoscopy.
Departments of Radiology, Neurosciences, and Dietetics, King's College Hospital, Denmark Hill, London SE5 9RS, England.
Ashley S
AS
Shaw
Mary A
MA
Ampong
Alan
A
Rio
Jean
J
McClure
P Nigel
PN
Leigh
Paul S
PS
Sidhu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000601:surgery / Q000628:therapy*; D004750:Enteral Nutrition / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D013530:Surgical Wound Infection; D016896:Treatment Outcome; D015430:Weight Gain