7199 Safety and efficacy of outpatient placement of percutaneous endoscopic gastrostomy feeding tubes using conscious sedation in patients with amyotropic lateral sclerosis.

Abstract

Patients with amyotropic lateral sclerosis (ALS) often develop dysphagia in the later stages of the disease process. This dysphagia may be coincident with a decline in pulmonary function. The current study was performed to demonstrate safety and efficacy of PEG placement in an outpatient population of ALS patients..Methods: Nineteen patients with dysphagia and weight loss were identified in Penn State's ALS clinic. They were referred for placement of PEG soon after weight loss became apparent. Patients were seen initially in the endoscopy unit the day of PEG placement (unless significant pulmonary concerns were present), and were observed overnight in the extended recovery unit after successful PEG placement. During the observation period, patients received prophylactic antibiotics, nutrition evaluation by a registered dietitian, and were monitored for complications; the patient and family were instructed on feedings and home support services. Results: Nineteen ALS patients were referred for outpatient PEG placement from 1997-1999. All had dysphagia as the primary complaint, and were referred for PEG placement at onset of weight loss. All but two patients underwent successful PEG placement using conscious sedation. One patient required general anesthesia because of inability to protect his airway; one patient (post-gastrectomy) required surgical gastrostomy placement for failure to identify light reflex at time of PEG. Only one post-PEG complication was noted; aspiration pneumonitis occurred in the patient requiring general anesthesia. One patient expired from respiratory failure 138 days after PEG placement. Serum albumin was 3.7 on average at time of referral for PEG, likely because the criteria for referral were early (at onset of weight loss), so patients were not significantly malnourished. No patient had a pre-PEG albumin less than 3.2. For those patients in whom followup data were available, serum albumin rose from 3.3 to 4.1 an average of 6 months after PEG placement. Conclusion: Outpatient placement of PEG feeding tubes using conscious sedation can be performed efficiently, safely, and with excellent results as part of a comprehensive, multi-specialty approach to patients with ALS. Patients with amyotropic lateral sclerosis (ALS) often develop dysphagia in the later stages of the disease process. This dysphagia may be coincident with a decline in pulmonary function. The current study was performed to demonstrate safety and efficacy of PEG placement in an outpatient population of ALS patients..Methods: Nineteen patients with dysphagia and weight loss were identified in Penn State's ALS clinic. They were referred for placement of PEG soon after weight loss became apparent. Patients were seen initially in the endoscopy unit the day of PEG placement (unless significant pulmonary concerns were present), and were observed overnight in the extended recovery unit after successful PEG placement. During the observation period, patients received prophylactic antibiotics, nutrition evaluation by a registered dietitian, and were monitored for complications; the patient and family were instructed on feedings and home support services. Results: Nineteen ALS patients were referred for outpatient PEG placement from 1997-1999. All had dysphagia as the primary complaint, and were referred for PEG placement at onset of weight loss. All but two patients underwent successful PEG placement using conscious sedation. One patient required general anesthesia because of inability to protect his airway; one patient (post-gastrectomy) required surgical gastrostomy placement for failure to identify light reflex at time of PEG. Only one post-PEG complication was noted; aspiration pneumonitis occurred in the patient requiring general anesthesia. One patient expired from respiratory failure 138 days after PEG placement. Serum albumin was 3.7 on average at time of referral for PEG, likely because the criteria for referral were early (at onset of weight loss), so patients were not significantly malnourished. No patient had a pre-PEG albumin less than 3.2. For those patients in whom followup data were available, serum albumin rose from 3.3 to 4.1 an average of 6 months after PEG placement. Conclusion: Outpatient placement of PEG feeding tubes using conscious sedation can be performed efficiently, safely, and with excellent results as part of a comprehensive, multi-specialty approach to patients with ALS.