Successful Percutaneous Gastrostomy Tube Placement with Fluoroscopy in ALS Patient Requiring 24/7 Ventilation (P3.430)

Objective: Case Report: Weight loss and decreased nutrition portend worse prognosis for patients with Amyotrophic Lateral Sclerosis(ALS). One avenue to combat weight loss in the setting of dysphagia is via gastrostomy(g-)tube nutrition. G-tube insertion techniques entail supine position and light sedation that can compromise weak respiratory function. Thus, patient’s diaphragm strength, represented by upright vs supine forced vital capacity(FVC), is considered a limiting factor for a g-tube to be inserted in ALS, to prevent procedure-associated respiratory failure. G-tubes are most often inserted in ALS patients with FVC30%, and guidelines maintain FVCu003e50% decreases risk of insertion-associated adverse events. Aerophagia is a common result of positive pressure ventilation(PPV) in ALS patients. Aerophagia can lead to gastric distension[6–8] which contributes to patients’ cardiopulmonary function, and can be limiting to quality of life and NIV compliance. In this case, an 82-year-old male with ALS on 24/7 ventilation, FVC unmeasurable, with dysphagia to saliva, aerophagia leading to severe bowel distension, and recent bowel obstruction, received bowel decompression and subsequent percutaneous venting g-tube placement with fluoroscopy under general anesthesia(GA). No narcotic or paralytic agents were used. Patient tolerated G-tube insertion and subsequent extubation to 24/7 non-invasive ventilation(NIV) following treatment with cough assist without complications. Subsequent lung volume recruitment increased. This case demonstrates that insertion of venting g-tube can relieve aerophagia-associated gastric distension, which can lead to altered cardiopulmonary function and patient discomfort, in patients with ALS on PPV. GA without use of narcotic and paralytic agents during g-tube insertion may aid postoperative respiratory recovery. Cough assist can be considered to aid extubation to NIV in patients on 24/7 ventilation. Percutaneous g-tube placement with fluoroscopy may be completed successfully in ALS patients on 24/7 ventilation with unmeasurable FVC, suggesting consideration be made for g-tube insertion in this population. Background: NA Design/Methods: NA Results: NA Conclusions: NA Study Supported by: NA Disclosure: Dr. Ajroud-Driss has nothing to disclose. Dr. Burian has nothing to disclose. Dr. Li has nothing to disclose. Dr. Wolfe has nothing to disclose.