Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS

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Abstract
Background: Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion. Objective: To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure. Methods: 25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) Results: The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (pConclusions: PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.