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Safety of Gastrostomy Tube Placement in Patients with Advanced Amyotrophic Lateral Sclerosis With Noninvasive Ventilation

Authors
 Eun Young Kim  ;  Seong Woong Kang  ;  Mi Ri Suh  ;  Jiho Jung  ;  Jihyun Park  ;  Won Ah Choi 
Citation
 JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, Vol.45(6) : 1338-1346, 2021-08 
Journal Title
JOURNAL OF PARENTERAL AND ENTERAL NUTRITION
ISSN
 0148-6071 
Issue Date
2021-08
MeSH
Amyotrophic Lateral Sclerosis* / complications ; Amyotrophic Lateral Sclerosis* / therapy ; Enteral Nutrition ; Gastrostomy ; Humans ; Noninvasive Ventilation* ; Vital Capacity
Keywords
amyotrophic lateral sclerosis ; gastrostomy ; noninvasive ventilation ; pulmonary rehabilitation
Abstract
Background: In patients with amyotrophic lateral sclerosis (ALS), bulbar muscle dysfunction can occur, which eventually requires the initiation of enteral tube feeding. However, there is no consensus on the optimal timing for the gastrostomy or the proper ventilator support method during the procedure. We aimed to investigate the safe range of gastrostomy according to respiratory support status and forced vital capacity (FVC) % of predicted values classification and to compare the safety of noninvasive and invasive mechanical ventilation during the procedure in ALS patients with FVC < 30% of predicted.

Methods: A total of 477 patients diagnosed with ALS at our institution from January 1, 2009, to December 31, 2018, were evaluated, and 105 patients were enrolled in this study. All medical records covering ventilation status and complications within 6 months to 1 year after the initial gastrostomy were gathered and reviewed.

Results: The gastrostomy procedure was considered safe regardless of FVC status or modality of respiratory support. There were complications related to the gastrostomy procedure in 6 of 105 patients and all were managed through conservative care. The incidence of complications, including respiratory ones, for noninvasive and invasive positive pressure ventilation was 5.5% and 9.6%, respectively, which were not statistically significantly different (P = .294).

Conclusion: The procedure and tube placement of a gastrostomy can be safely performed in ALS patients with minimal FVC regardless of ventilation invasiveness. We suggest that there should be a new standard for FVC % of predicted to facilitate performing gastrostomy in ALS patients.
Full Text
https://aspenjournals.onlinelibrary.wiley.com/doi/full/10.1002/jpen.2018
DOI
10.1002/jpen.2018
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seong Woong(강성웅) ORCID logo https://orcid.org/0000-0002-7279-3893
Park, Jihyun(박지현) ORCID logo https://orcid.org/0000-0002-2172-1072
Choi, Won Ah(최원아) ORCID logo https://orcid.org/0000-0003-0403-8869
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187451
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