Fluoroscopy-guided percutaneous gastrostomy with pull technique for the amyotrophic lateral sclerosis patients with very low vital capacity.

BACKGROUND: The purpose of this study was to evaluate the safety and usefulness of fluoroscopy-guided percutaneous gastrostomy (FPG) in patients with amyotrophic lateral sclerosis (ALS) using a large-profile gastrostomy tube accompanied by the pull technique. This procedure was done without an accompanying endoscopy or gastropexy. METHODS: Thirty-six patients with ALS underwent FPG using a large-profile gastrostomy tube accompanied by the pull technique. A 24 Fr pull-type tube was inserted under fluoroscopic guidance into the mouth and pulled to the upper-abdominal puncture site using a snare. The technical success rate, occurrence of complications, and clinical outcomes were evaluated. RESULTS: The technical success rate was 100%. There were no procedure-related mortalities or respiratory complications. The mean forced vital capacity of the patients was 732 mL (17.7% of the normal predicted value). During the procedure, 16 patients required ventilator support by nasal mask or tracheostomy. The tube indwelling period ranged from 1 to 24 months (average, 9.3). During this period, all the tubes were maintained in a proper position. In 18 patients, the tube was exchanged after 6 months without any problems. CONCLUSIONS: The FPG procedure using a 24 Fr tube and the pull technique shows a high rate of technical success. This procedure has a low risk for respiratory complications because endoscopic guidance is not needed. In addition, gastropexy is not required, which allows a large-profile catheter to be inserted during a single procedure.ope