Fluoroscopy-guided percutaneous gastrostomy with pull technique for the amyotrophic lateral sclerosis patients with very low vital capacity.

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.