22 - Safety and Efficacy of Percutaneous Gastrostomy in Patients with Amyotrophic Lateral Sclerosis: A Retrospective Study

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that affects the nerves in the brain and spinal cord. It is estimated that close to 80% of ALS patients have swallowing difficulties, necessitating enteral nutrition support {1}. Percutaneous gastrostomy (PG Tube) placement is a common intervention; however, placement is challenging given the breathing and swallowing difficulties encountered. This study retrospectively examines the outcomes of PG tube placement over a 3-year period, focusing on the procedure's safety and efficacy.

Materials and Methods:

This was an IRB-approved retrospective study of all gastrostomy tubes placed by interventional radiology (IR) in patients with ALS over a 3-year period. All studies were performed with the assistance of anesthesiology, and ASA classification was determined from their notes. Technical and clinical success, as well as complications, were documented and reviewed. The primary outcome was 30-day mortality following gastrostomy tube placement. 

Results:

148 PG procedures on 144 patients were reviewed. 1 patient was excluded as they were in another IRB study. The average age of patients was 62.8 years (25-90 years), with an equal distribution of 72 females and 72 males. The technical success rate of G-tube placement was 98%, with only 3 failures out of 148 procedures. The average fluoroscopy time for the procedures was 4.8 minutes (+/- 2.9 minutes), and the average radiation dose was 50.8 mGy (+/- 104.9mGy).  117 patients were ASA Grade 3, 21 were Grade 4, and 10 were Grade 2. The ASA grade did not correlate with primary placement success or complication rate.

No major complications were reported. Minor complications included 3 failed attempts at G-tube placement (2%). One instance of respiratory arrest was treated with intubation and transferred to the intensive care unit for further management. Post-procedure follow-up at one month indicated no need for re-intervention or management of complications. No mortality events were noted at the one month follow up.

Conclusion: Percutaneous gastrostomy tube placement in ALS patients is a generally safe procedure with a high technical success rate and low complication rate. These findings support the use of gastrostomy feeding in ALS patients with severe dysphagia to improve nutritional support and potentially enhance their quality of life.