Percutaneous endoscopic gastrostomy tube placement in amyotrophic lateral sclerosis: a case series with a multidisciplinary, team-based approach

Abstract

Background: Amyotrophic lateral sclerosis is a progressive neurodegenerative disease that affects motor neurons. When bulbar symptoms impair oral nutritional uptake, guidelines recommend percutaneous endoscopic gastrostomy tube placement. Studies evaluating the appropriate timing and procedural method of placement of gastrostomy tubes have been published; however, no study has been published that evaluated outcomes from a team-based approach to percutaneous endoscopic gastrostomy placement.

Methods: A retrospective cohort study was performed to evaluate 26 amyotrophic lateral sclerosis patients with various respiratory statuses, who had percutaneous endoscopic gastrostomy tubes placed using a multidisciplinary approach that included neurology, anesthesia, general surgery, and gastroenterology. Preprocedural risks and postprocedural outcomes were compared with previously published studies.

Results: The mean age at percutaneous endoscopic gastrostomy placement was 66 years. The mean forced vital capacity was 54% and 18 patients (72%) were on noninvasive ventilation. There were 3 minor complications and no major complications prior to index discharge. The mean length of hospital stay was 3 days. There were no delayed complications or deaths. All patients alive at 6 months and 1 year were using their gastrostomy tubes without problems.

Conclusions: Compared to previously published studies, a multidisciplinary approach to percutaneous endoscopic gastrostomy placement had a better placement rate, fewer minor and major complications, and a comparative length of stay. These data support the effectiveness of a multidisciplinary approach to increase the success and survival rates of patients with amyotrophic lateral sclerosis.

Keywords: Percutaneous endoscopic gastrostomy; amyotrophic lateral sclerosis; nutrition.