title: Fluoroscopy-guided percutaneous gastrostomy with pull technique for the amyotrophic lateral sclerosis patients with very low vital capacity.
abstract: BACKGROUND
  The purpose of this study was to evaluate the safety and usefulness of fluoroscopy-guided percutaneous gastrostomy (FPG) in patients with amyotrophic lateral sclerosis (ALS) using a large-profile gastrostomy tube accompanied by the pull technique. This procedure was done without an accompanying endoscopy or gastropexy.
  
  
  METHODS
  Thirty-six patients with ALS underwent FPG using a large-profile gastrostomy tube accompanied by the pull technique. A 24 Fr pull-type tube was inserted under fluoroscopic guidance into the mouth and pulled to the upper-abdominal puncture site using a snare. The technical success rate, occurrence of complications, and clinical outcomes were evaluated.
  
  
  RESULTS
  The technical success rate was 100%. There were no procedure-related mortalities or respiratory complications. The mean forced vital capacity of the patients was 732 mL (17.7% of the normal predicted value). During the procedure, 16 patients required ventilator support by nasal mask or tracheostomy. The tube indwelling period ranged from 1 to 24 months (average, 9.3). During this period, all the tubes were maintained in a proper position. In 18 patients, the tube was exchanged after 6 months without any problems.
  
  
  CONCLUSIONS
  The FPG procedure using a 24 Fr tube and the pull technique shows a high rate of technical success. This procedure has a low risk for respiratory complications because endoscopic guidance is not needed. In addition, gastropexy is not required, which allows a large-profile catheter to be inserted during a single procedure.
authors.affiliation: Department of Rehabilitation Medicine, Eulji University Hospital, Daejeon, Korea.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Seong-Woong
authors.initials: SW
authors.lastname: Kang
authors.forename: Jong Yun
authors.initials: JY
authors.lastname: Won
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Uhm
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome; D014797:Vital Capacity