Amyotrophic Lateral Sclerosis: Enteral Nutrition Provision—Endoscopic or Radiologic Gastrostomy?

Abstract

Results show PRG to be the method of choice.

Mushroom-cage gastrostomy tube placement in patients with amyotrophic lateral sclerosis: a 5-year experience in 104 patients in a single institution

“…The most common complication encountered following RIG placement was superficial peri-stomal infection, managed adequately with local therapy. Our incidence of all complications was 22.1%, which is higher than other series quoting complication rates of 1.0-13.0% [10,11,22,23]. However, only three major complications occurred; the remainder were of a minor nature.…”

“…A 30-day mortality rate of between 0.5-17% has been reported with RIG tube insertion in patients with a variety of underlying diseases other than ALS [10,23,27]. Thornton et al, in a series of ALS patients using conscious sedation and inserting 14-F gastrostomy tubes, described one death (peritonitis, 1/25, 4%) directly related to the RIG insertion [22]. Our mortality rate may be further improved with better patient The complications are divided into early or late, peri-procedural, minor or major as described in the text.…”

“…The technique for radiological-guided gastrostomy feeding tube insertion has been previously described [9,[21][22][23], each description with modifications to the basic technical principles. We have employed a specific technique throughout, but with experience important modifications have evolved.…”

ALS multidisciplinary clinic and survival

“…Patients are reviewed approximately every three months. Nutritional status and bulbar function were closely monitored; patients were informed of the benefits of early percutaneous gastrostomy (PEG) placement, according to well established criteria [16,22]. Patients were considered followed by ALS MDC if they were visited in at least two occasions.…”

Frequency, timing and outcome of gastrostomy tubes for amyotrophic lateral sclerosis/motor neurone disease

“…Because this cohort was studied before the introduction of guidelines concerning respiratory assessment before PEG, it is possible that Scottish patients had procedures when their respiratory capacity was sub-optimal. More recently investigators have demonstrated that radiologically guided gastrostomy is associated with a lower rate of technical complications [18]. Ideally, different feeding regimes should be tested in a randomised controlled trial, with either survival or health-related quality of life as an outcome measure.…”