Gastrostomy tube placement is safe in advanced amyotrophic lateral sclerosis

Abstract

Objectives: 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.

Discussion: 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.

Keywords:

• Amyotrophic lateral sclerosis
• percutaneous endoscopic gastrostomy
• ALS
• PEG
• G-tube
• feeding tube

Acknowledgements

The authors thank the Greater Chicago Chapter of the ALS Association, multidisciplinary team members at the ALS Association Certified Center of Excellence at the University of Chicago, and our patients. We also thank Sydeaka Watson for her assistance with statistical analysis.