title: Mushroom-cage gastrostomy tube placement in patients with amyotrophic lateral sclerosis: a 5-year experience in 104 patients in a single institution.
abstract: To review our experience of placement of a mushroom-cage gastrostomy tube (Entristar, Tyco Healthcare, Mansfield, MA), using radiological guidance, in patients with amyotrophic lateral sclerosis (ALS). All procedures were performed under local anaesthesia without sedation. Complications were recorded as peri-procedural, early (<24 h), late (>24 h), major or minor. Deaths were recorded as related to the underlying ALS or secondary to radiological-inserted gastrostomy (RIG) placement. Replacement RIG tube rate was recorded. Over a 5-year period RIG tubes were placed in 104 patients with ALS (male n = 52, female n = 52), with a median age of 62 years (range 34-86 years). All procedures were technically successful. Of the RIG procedures, 21/104 (20.2%) were performed with respiratory support. The 30-day mortality rate was 7/104 (6.7%); no patient died as a result of the procedure. There were 23/104 (22.1%) complications overall; 20/104 (19.2%) were minor and 3/104 (2.9%) major, requiring surgery (n = 2) and radiological-guided abscess drainage (n = 1). A median interval between replacement RIG procedures in 20/104 (19.2%) patients was 141.5 days (range 43-537 days). A mushroom-cage RIG tube may be safely and effectively inserted in a 'one-step' radiological procedure and may replace endoscopic-inserted gastrostomy tubes in the nutritional management of ALS.
authors.affiliation: Department of Radiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
authors.forename: Dylan
authors.initials: D
authors.lastname: Lewis
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Ampong
authors.forename: Alan
authors.initials: A
authors.lastname: Rio
authors.forename: Emma
authors.initials: E
authors.lastname: Willey
authors.forename: Julia
authors.initials: J
authors.lastname: Johnson
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Shaw
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Ellis
authors.forename: Ammar
authors.initials: A
authors.lastname: Al-Chalabi
authors.forename: P Nigel
authors.initials: PN
authors.lastname: Leigh
authors.forename: Paul S
authors.initials: PS
authors.lastname: Sidhu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D011859:Radiography; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome