title: Gastrostomy tube placement is safe in advanced amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  To evaluate the safety and effect on survival of insertion of a gastrostomy tube (G-tube) in patients with amyotrophic lateral sclerosis (ALS) who have upright forced vital capacity (uFVC) ≤ 50% predicted. Current guidelines, which are based on higher rates of post-procedure complications in ALS patients with advanced respiratory dysfunction, have led to a recommendation to perform G-tube insertion before the FVC drops to <50% predicted, even when the patient has no significant dysphagia.
  
  
  METHODS
  We assessed 41 ALS patients who received a G-tube, mostly by insertion of a percutaneous endoscopic gastrostomy (PEG) tube by a dedicated team that included a gastroenterologist and one of two anesthesiologists using Monitored Anesthesia Care with deep sedation, and 61 patients who did not receive a G-tube. uFVC was ≤50% predicted in 12 of 41 patients who received a G-tube and in 18 of 61 who did not.
  
  
  RESULTS
  The procedure was safe regardless of FVC status, with low rates of post-operative complications in both low and high FVC groups. There was no survival benefit for patients who received a G-tube when compared with those who did not.
  
  
  CONCLUSIONS
  PEG insertion is safe in ALS patients with significant respiratory muscle weakness when performed by a dedicated team, which suggests that the recommendation for G-tube placement should not be based on the patient's respiratory status.
authors.affiliation: a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Kak
authors.affiliation: a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Naoum P
authors.initials: NP
authors.lastname: Issa
authors.affiliation: a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Raymond P
authors.initials: RP
authors.lastname: Roos
authors.affiliation: b Department of Anesthesiology , Northwestern Memorial Hospital , Chicago , IL , USA.
authors.forename: Bobbie Jean
authors.initials: BJ
authors.lastname: Sweitzer
authors.affiliation: c Department of Anesthesiology and Critical Care , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Ori
authors.initials: O
authors.lastname: Gottlieb
authors.affiliation: d Department of Medicine , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Guralnick
authors.affiliation: d Department of Medicine , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: White
authors.affiliation: d Department of Medicine , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Semrad
authors.affiliation: a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Betty
authors.initials: B
authors.lastname: Soliven
authors.affiliation: e Greater Chicago Chapter of the ALS Association , Chicago , IL , USA.
authors.forename: Joumana
authors.initials: J
authors.lastname: Baroody
authors.affiliation: a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Rezania
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000601:surgery*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D016019:Survival Analysis; D016896:Treatment Outcome; D064232:Visual Analog Scale; D014797:Vital Capacity / Q000502:physiology*
keywords: ALS; Amyotrophic lateral sclerosis; G-tube; PEG; feeding tube; percutaneous endoscopic gastrostomy