title: Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) tube placement is recommended in amyotrophic lateral sclerosis (ALS) patients with dysphagia to provide reliable access for medications and nutrition. It is preferably done while forced vital capacity (FVC) is greater than 50% of predicted to reduce risk of postprocedural respiratory complications. Percutaneous radiologic gastrostomy has been shown to have higher success rates and lower complication rates compared with PEG. The authors sought to investigate the safety of PEG placement in ALS patients with varying respiratory compromise.
  
  
  METHODS
  The records of 21 patients with ALS who underwent PEG tube placement from October 2010 to October 2013 were retrospectively reviewed to determine rates of successful placement, complication, mortality and survival.
  
  
  RESULTS
  PEG was placed successfully in 95.2% of patients. There was 1 major complication, procedure-related death, and failed placement in a patient with FVC 15% predicted who developed procedure-related aspiration and hypoxic respiratory failure and death 8 days after failed PEG attempt. Minor complications included 3 patients with minor pain at insertion site, 1 patient with minor bleeding requiring cauterization and 2 patients requiring PEG tube replacement within 6 months of procedure for accidental dislodgement. After PEG placement, median survival was 327 days (95% confidence interval: 180-687).
  
  
  CONCLUSIONS
  In conclusion, PEG tube placement in patients with ALS seems to be a safe procedure in patients without significant respiratory compromise. In patients with FVC <50%, based on literature review and the results of this study, the authors recommend percutaneous radiologic gastrostomy over PEG placement.
authors.affiliation: Internal Medicine Residency Training Program The University of Alabama at Birmingham (KBR), Birmingham, Alabama; Department of Anesthesiology (MCP), The University of Alabama at Birmingham, Birmingham, Alabama; and Division of Gastroenterology and Hepatology (CMW, SP), The University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Kirk B
authors.initials: KB
authors.lastname: Russ
authors.forename: Mark C
authors.initials: MC
authors.lastname: Phillips
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.forename: Shajan
authors.initials: S
authors.lastname: Peter
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008875:Middle Aged