Gastrostomy tube placement is safe in advanced amyotrophic lateral sclerosis

Neurol Res. 2017 Jan;39(1):16-22. doi: 10.1080/01616412.2016.1259028. Epub 2016 Nov 23.


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: ALS; Amyotrophic lateral sclerosis; G-tube; PEG; feeding tube; percutaneous endoscopic gastrostomy.

MeSH terms

  • Aged
  • Amyotrophic Lateral Sclerosis / surgery*
  • Enteral Nutrition / adverse effects*
  • Female
  • Gastrostomy / instrumentation
  • Gastrostomy / methods*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Postoperative Complications / physiopathology*
  • Survival Analysis
  • Treatment Outcome
  • Visual Analog Scale
  • Vital Capacity / physiology*