Gastrostomy Tube Placement by Endoscopy Versus Radiologic Methods in Patients with ALS: A Retrospective Review of Complications and Outcome (P01.101)

Objective: To better define the best method of gastrostomy (G) tube placement for patients with amyotrophic lateral sclerosis (ALS). Background Weight loss and nutritional status are prognostic factors for survival during the course of ALS. Ultimately, a G-tube is often needed to deliver nutrition. G-tube placement can be performed by percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) procedures. Further, RIG can be performed as internal-external pull-type (pull-type-RIG) or external-internal (push-type-RIG) methods. Safe G-tube placement must overcome specific challenges in the ALS population. Most ALS patients in need of G-tubes have concomitant respiratory failure. Aspiration, post-operative pneumonia, and peri-procedure respiratory failure are important concerns for ALS patients that undergo surgical procedures that necessitate sedative medications and anesthetic agents. The best method for G-tube placement has not been well defined in this population. Design/Methods: Retrospective cohort study of ALS patients that underwent G-tube placement by PEG or RIG. Results: Statistical analysis was performed on consecutive ALS patients that underwent G-tube placement by PEG and RIG. 50 patients were analyzed in each group. The two methods were compared with respect to peri-interventional aspects and clinical results. Parameters assessed included procedure success rate, peri- and post-procedural complications, length of hospital stay, 6-month mortality, and pain. Age, FVC, and ALSFRS were assessed in separate analysis to determine their impact on the success and complication rate of both procedure types. Subgroup analysis was performed to compare these parameters in the pull-type-RIG and push-type-RIG groups. Conclusions: Procedural related complications, including aspiration and post-operative pneumonia, are more common in ALS patients that undergo G-tube placement by the PEG method. RIG is a safer and more efficacious alternative in patients with ALS. We speculate that the limited use of general anesthesia and sedation during the RIG procedure accounts for the superior outcome in the RIG population. Disclosure: Dr. Allen has nothing to disclose. Dr. Hall has nothing to disclose. Dr. Wallery has nothing to disclose. Dr. Ajroud-Driss has nothing to disclose. Dr. Armstrong has nothing to disclose. Dr. McManus has nothing to disclose. Dr. Cook has nothing to disclose. Dr. Sufit has nothing to disclose. Dr. Chrisman has nothing to disclose. Dr. Wolfe has nothing to disclose. Dr. Siddique has nothing to disclose.