title: Outcomes of percutaneous endoscopic gastrostomy tube insertion in respiratory impaired amyotrophic lateral sclerosis patients under noninvasive ventilation.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) tube placement in amyotrophic lateral sclerosis (ALS) patients with impaired respiratory function is associated with an increased risk of peri-procedural and post-interventional complications. It was the aim of the study to analyze peri- and post-interventional complications and survival after PEG tube placement under noninvasive ventilation (NIV) in ALS patients with various degrees of respiratory impairment.
  
  
  METHODS
  Twenty-six subjects were included in this retrospective case study. Prior to PEG tube placement, training with ventilatory support via an oronasal mask was performed with ALS subjects on the pneumology ward. PEG placement was then performed under continuous NIV. FVC, sniff nasal inspiratory pressure, and demographic data were assessed. Complication rates and 1-month and overall survival rates were analyzed.
  
  
  RESULTS
  There were no deaths within 24 hours after PEG placement. One subject died within the first month. The mean survival rate after PEG was 12 ± 10 months (range 0.6-42 months). There was no difference in post-PEG survival between subjects with moderately (> 50%) and severely (< 50%) impaired FVC.
  
  
  CONCLUSIONS
  In this case series, PEG tube insertion was associated with minimal peri- and post-procedural complications. The low complication rate might be due to the systematic use of procedural NIV in ALS subjects.
authors.affiliation: Neuromuscular Diseases Unit/Amyotrophic Lateral Sclerosis Clinic, Cantonal Hospital, Greithstrasse 20, St Gallen 9007, Switzerland. david.czell@gmx.ch
authors.forename: David
authors.initials: D
authors.lastname: Czell
authors.forename: Matthias
authors.initials: M
authors.lastname: Bauer
authors.forename: Janek
authors.initials: J
authors.lastname: Binek
authors.forename: Otto D
authors.initials: OD
authors.lastname: Schoch
authors.forename: Markus
authors.initials: M
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D014797:Vital Capacity