Percutaneous Radiologic Gastrostomy in Patients With Amyotrophic Lateral Sclerosis on Noninvasive Ventilation

Objective: To determine the safety and feasibility of percutaneous radiologic gastrostomy (PRG) tube placement in patients with amyotrophic lateral sclerosis (ALS) with too low a vital capacity to be weaned off noninvasive positive pressure ventilation (NPPV). Design: Five-year follow-up cohort study. Setting: Inpatient pulmonary rehabilitation hospital. Participants: Patients with ALS (N=25) with dysphagia on NPPV. Interventions: PRG tube placement was performed. During the procedure, all subjects used NPPV via nasal masks. No sedatives or narcotics were administered for premedication. Main Outcome Measures: Success and complication rates after PRG tube placement, and mean survival after the procedure. Results: For the 25 patients enrolled, mean percent forced vital capacity (FVC) was 33.3 +/- 17.8% seated (n=19) and 25.3 +/- 12.0% supine (n=18). FVCs could not be measured in patients who could not tolerate being off NPPV. PRG placement was 100% successful technically. Mean survival for the 25 patients was 32.1 months. Conclusions: The application of NPPV during PRG was found to be a successful, safe means of providing nutrition care for patients with ALS with too low an FVC to be off NPPV. We advocate that PRG be considered the treatment of choice for nutritional care in patients with ALS on NPPV.