title: Safety of unsedated PEG placement using transoral ultrathin endoscopy in patients with amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  In patients with amyotrophic lateral sclerosis (ALS), percutaneous endoscopic gastrostomy (PEG) placement under sedation often causes apnea or hypoventilation. The aim of the present study was to assess whether unsedated PEG placement in ALS patients using ultrathin endoscopy (UTE) via the transoral route can improve safety.
  
  
  METHODS
  Between 2003 and 2013, PEG placement was identified and reviewed in 45 patients with ALS. PEG was performed in 14 patients using transoral UTE without sedation (UTE group), 17 patients using conventional normal-diameter esophagogastroduodenoscopy (C-EGD) without sedation (unsedated C-EGD group) and 14 patients using C-EGD with sedation (sedated C-EGD group). We compared the clinical features, cardiopulmonary data before and during PEG placement, and complications related to PEG placement among the three groups.
  
  
  RESULTS
  There were no significant differences in age, male/female ratio, forced vital capacity, blood pressure, oxygen saturation before and during PEG, or major complications among the three groups. No minor complications were observed in the UTE group, whereas apnea and/or hypoventilation were observed in the sedated C-EGD group and aspiration pneumonia was observed in the unsedated C-EGD group.
  
  
  CONCLUSIONS
  Unsedated PEG placement using transoral UTE in ALS patients is a safe method.
authors.affiliation: a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.affiliation: a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Goshi
authors.affiliation: a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawauchi
authors.affiliation: a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Nishigaki
authors.affiliation: a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Mizuno
authors.affiliation: a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Hashimoto
authors.affiliation: a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: b Division of Endoscopy , Niigata University Medical and Dental Hospital , Niigata , Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: c Department of Neurology , Niigata University Brain Research Institute , Niigata , Japan.
authors.forename: Tetsutaro
authors.initials: T
authors.lastname: Ozawa
authors.affiliation: c Department of Neurology , Niigata University Brain Research Institute , Niigata , Japan.
authors.forename: Masatoyo
authors.initials: M
authors.lastname: Nishizawa
authors.affiliation: a Department of Gastroenterology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyagi
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology / Q000628:therapy*; D001049:Apnea / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016292:Procedural Sedation / Q000009:adverse effects*; D054810:Deep Sedation / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation; D006785:Hospitals, University; D006801:Humans; D007040:Hypoventilation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012131:Respiratory Insufficiency / Q000209:etiology*
keywords: ALS; PEG; Pneumonia; Sedation; Transoral route; Ultrathin endoscopy