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Gastrostomy tube placement is safe in advanced amyotrophic lateral sclerosis.
Kak, Manisha; Issa, Naoum P; Roos, Raymond P; Sweitzer, Bobbie Jean; Gottlieb, Ori; Guralnick, Amy; White, Steven R; Semrad, Carol E; Soliven, Betty; Baroody, Joumana; Rezania, Kourosh.
Afiliación
  • Kak M; a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
  • Issa NP; a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
  • Roos RP; a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
  • Sweitzer BJ; b Department of Anesthesiology , Northwestern Memorial Hospital , Chicago , IL , USA.
  • Gottlieb O; c Department of Anesthesiology and Critical Care , The University of Chicago Medical Center , Chicago , IL , USA.
  • Guralnick A; d Department of Medicine , The University of Chicago Medical Center , Chicago , IL , USA.
  • White SR; d Department of Medicine , The University of Chicago Medical Center , Chicago , IL , USA.
  • Semrad CE; d Department of Medicine , The University of Chicago Medical Center , Chicago , IL , USA.
  • Soliven B; a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
  • Baroody J; e Greater Chicago Chapter of the ALS Association , Chicago , IL , USA.
  • Rezania K; a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
Neurol Res ; 39(1): 16-22, 2017 Jan.
Article en En | MEDLINE | ID: mdl-27876446
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.
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Gastrostomía / Capacidad Vital / Nutrición Enteral / Esclerosis Amiotrófica Lateral Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Neurol Res Año: 2017 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Buscar en Google
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Imprimir
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PubMed Links

Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Gastrostomía / Capacidad Vital / Nutrición Enteral / Esclerosis Amiotrófica Lateral Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Neurol Res Año: 2017 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido