HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2243010909v1 224/3/713    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thornton, F. J. Articles by Lee, M. J. Search for Related Content PubMed PubMed Citation Articles by Thornton, F. J. Articles by Lee, M. J.

Amyotrophic Lateral Sclerosis: Enteral Nutrition Provision—Endoscopic or Radiologic Gastrostomy?¹

¹ From the Departments of Interventional Radiology (F.J.T., T.F., F.P.M., M.J.L.) and Neurology (M.A., O.H.), Beaumont Hospital, PO Box 1297, Beaumont Rd, Dublin 9, Ireland. Received May 11, 2001; revision requested July 9; final revision received February 14, 2002; accepted March 1. Address correspondence to M.J.L. (e-mail: leebeau@iol.ie).

PURPOSE: To retrospectively evaluate gastrostomy placement in patients with amyotrophic lateral sclerosis (ALS) to determine the insertion method of choice.

MATERIALS AND METHODS: During 3 years, 36 patients with ALS (19 men, 17 women; mean age, 54 years; age range, 37–69 years) underwent gastrostomy. Twenty patients were primarily referred for percutaneous endoscopic gastrostomy (PEG) and 16 for percutaneous radiologic gastrostomy (PRG). Gastrostomy method, success rate of each technique, and reason for procedure failure were reviewed in each patient. Forced vital capacity (FVC) prior to gastrostomy was recorded. PEG was performed with a pull-through technique after transillumination of the abdominal wall. PRG was performed with fluoroscopic guidance and T-fastener gastropexy. A log-rank test was used to compare survival rates after PRG and PEG, and a Wilcoxon rank sum test was used to evaluate the influence of declining FVC on PEG success. The Kaplan-Meier product limit method was used to estimate survival probabilities.

RESULTS: Of the 20 patients referred for PEG, 11 had successful results. The nine failures (45%) resulted from failure to transilluminate the abdominal wall. All 16 patients primarily referred for PRG underwent successful gastrostomy. The nine patients in whom PEG failed underwent subsequent successful PRG. In patients with diaphragmatic palsy and a high subcostal stomach, an angled subcostal approach (n = 6) or intercostal approach (n = 2) was required at PRG. One death occurred in the PEG group (9%) because of procedure-related aspiration, and a second patient from the PEG group required laparotomy for postprocedural peritonitis. One death occurred in the PRG group (4%) because of inadvertent placement of the feeding tube in the peritoneal cavity. There was no significant difference between PEG and PRG in patient survival. FVC did not have a statistically significant influence on PEG failure.

CONCLUSION: Results show PRG to be the method of choice.

© RSNA, 2002

Index terms: Amyotrophic lateral sclerosis, 72.613 • Gastrostomy, 72.1267 • Stomach, interventional procedures, 72.1267 • Stomach, surgery, 72.1267

This article has been cited by other articles:

				C. J McDermott and P. J Shaw Diagnosis and management of motor neurone disease BMJ, March 22, 2008; 336(7645): 658 - 662. [Full Text] [PDF]

				A. S. Shaw, M. A. Ampong, A. Rio, J. McClure, P. N. Leigh, and P. S. Sidhu Entristar Skin-Level Gastrostomy Tube: Primary Placement with Radiologic Guidance in Patients with Amyotrophic Lateral Sclerosis Radiology, November 1, 2004; 233(2): 392 - 399. [Abstract] [Full Text] [PDF]

				A Chio, R Galletti, C Finocchiaro, D Righi, M A Ruffino, A Calvo, N Di Vito, P Ghiglione, A A Terreni, and R Mutani Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS J. Neurol. Neurosurg. Psychiatry, April 1, 2004; 75(4): 645 - 647. [Abstract] [Full Text] [PDF]

				P N Leigh, S Abrahams, A Al-Chalabi, M-A Ampong, L H Goldstein, J Johnson, R Lyall, J Moxham, N Mustfa, A Rio, et al. The management of motor neurone disease J. Neurol. Neurosurg. Psychiatry, December 1, 2003; 74(90004): iv32 - 47. [Full Text] [PDF]

				B J Traynor, M Alexander, B Corr, E Frost, and O Hardiman Effect of a multidisciplinary amyotrophic lateral sclerosis (ALS) clinic on ALS survival: a population based study, 1996-2000 J. Neurol. Neurosurg. Psychiatry, September 1, 2003; 74(9): 1258 - 1261. [Abstract] [Full Text] [PDF]