title: Evaluation of two different methods for per-oral gastrostomy tube placement in patients with motor neuron disease (MND): PIG versus PEG procedures.
abstract: Placement of a gastrostomy tube remains the gold standard procedure to maintain nutrition in patients with motor neuron disease (MND) and bulbar muscle weakness. Percutaneous endoscopic gastrostomy (PEG) is the most commonly used procedure in this context. Per-oral image guided gastrostomy (PIG) is a new hybrid technique used successfully in non-MND patients. We have modified the PIG technique to improve patient tolerability and have undertaken a pilot evaluation of PIG compared to PEG in MND patients. Nineteen PIG and 16 PEG procedures performed over a period of four years were evaluated. Pre-procedural forced vital capacity (FVC), procedural oxygen saturation, post-procedural complications and survival duration were recorded. Results showed that a gastrostomy tube was successfully placed in 95% of the PIG group and 80% of the PEG group. Rates of minor complications were comparable in both groups (21% in PIG, 23% in PEG). No life-threatening complications occurred in either group. Procedural mean oxygen saturations were higher in the PIG group compared to the PEG group (p < 0.001). No significant survival differences were observed. This study provides evidence for the use of the PIG procedure as a safe and well tolerated alternative to PEG in MND patients.
authors.affiliation: Academic Neurology Unit, University of Sheffield, Sheffield, UK.
authors.forename: Govindsinh
authors.initials: G
authors.lastname: Chavada
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Nayal
authors.forename: Fred
authors.initials: F
authors.lastname: Lee
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Webber
authors.forename: Mark
authors.initials: M
authors.lastname: McAlindon
authors.forename: Theresa
authors.initials: T
authors.lastname: Walsh
authors.forename: Hannah
authors.initials: H
authors.lastname: Hollinger
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McDermott
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Shaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000178:diet therapy* / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies