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Fluoroscopy‐Guided Percutaneous Gastrostomy With Pull Technique for the Amyotrophic Lateral Sclerosis Patients With Very Low Vital Capacity
Author(s) -
Park Jung Hyun,
Kang SeongWoong,
Won Jong Yun,
Uhm Chang Wook
Publication year - 2010
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607110362528
Subject(s) - medicine , fluoroscopy , gastropexy , feeding tube , gastrostomy , amyotrophic lateral sclerosis , percutaneous endoscopic gastrostomy , surgery , dysphagia , percutaneous , sedation , catheter , disease , finance , stomach , peg ratio , economics
Background: The purpose of this study was to evaluate the safety and usefulness of fluoroscopy‐guided percutaneous gastrostomy (FPG) in patients with amyotrophic lateral sclerosis (ALS) using a large‐profile gastrostomy tube accompanied by the pull technique. This procedure was done without an accompanying endoscopy or gastropexy. Methods: Thirty‐six patients with ALS underwent FPG using a large‐profile gastrostomy tube accompanied by the pull technique. A 24 Fr pull‐type tube was inserted under fluoroscopic guidance into the mouth and pulled to the upper‐abdominal puncture site using a snare. The technical success rate, occurrence of complications, and clinical outcomes were evaluated. Results: The technical success rate was 100%. There were no procedure‐related mortalities or respiratory complications. The mean forced vital capacity of the patients was 732 mL (17.7% of the normal predicted value). During the procedure, 16 patients required ventilator support by nasal mask or tracheostomy. The tube indwelling period ranged from 1 to 24 months (average, 9.3). During this period, all the tubes were maintained in a proper position. In 18 patients, the tube was exchanged after 6 months without any problems. Conclusions: The FPG procedure using a 24 Fr tube and the pull technique shows a high rate of technical success. This procedure has a low risk for respiratory complications because endoscopic guidance is not needed. In addition, gastropexy is not required, which allows a large‐profile catheter to be inserted during a single procedure.