Department of Neurology, Division of Neuromuscular Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
Amyotroph Lateral Scler Frontotemporal Degener. 2013 May;14(4):308-14. doi: 10.3109/21678421.2012.751613. Epub 2013 Jan 4.
Gastrostomy tube placement for malnutrition and weight loss stabilization occurs in many patients with ALS. We sought to compare the outcome and complications of gastrostomy tube placement by endoscopic (PEG) and multiple radiologic (RIG) methods in ALS patients. A retrospective analysis was conducted on all ALS patients evaluated at Northwestern University who received gastrostomy tubes between January 2009 and March 2012. One hundred and eight gastrostomy tube attempts were made on a total of 100 different patients. Failed gastrostomy tube placement occurred in 15.7% of PEGs and 1.9% of RIGs. Post-procedure aspiration was recognized after 10.5% PEG and 0 RIG attempts. Multivariate analysis revealed a linear increase in risk of post-procedure aspiration for every increase in ALSFRS swallow score. No statistically significant differences in failure or complications were observed when comparing two different methods of RIG (push-type vs. pull-type). Our findings support gastrostomy tube placement by radiographic methods in ALS patients. Gastrostomy tube placement by RIG was more often successful and less often associated with aspiration. Our findings add to the growing body of literature that argues for early gastrostomy tube placement in young patients with prominent bulbar involvement.
胃造口管放置术用于治疗营养不良和体重减轻的稳定，在许多 ALS 患者中都会进行。我们旨在比较经内镜（PEG）和多次放射学（RIG）方法放置胃造口管在 ALS 患者中的结果和并发症。对 2009 年 1 月至 2012 年 3 月在西北大学接受胃造口管的所有 ALS 患者进行了回顾性分析。总共对 100 名不同的患者进行了 108 次胃造口管尝试。PEG 组的胃造口管放置失败率为 15.7%，RIG 组为 1.9%。PEG 尝试后有 10.5%发生了术后吸入，RIG 尝试后则没有。多变量分析显示，ALSFRS 吞咽评分每增加一分，术后吸入的风险就会线性增加。当比较两种不同的 RIG 方法（推注式与拉拔式）时，在失败或并发症方面没有观察到统计学上的显著差异。我们的研究结果支持在 ALS 患者中采用放射学方法放置胃造口管。RIG 放置胃造口管的成功率更高，与吸入的相关性更小。我们的研究结果增加了越来越多的文献证据，即主张对有明显球部受累的年轻患者早期进行胃造口管放置。
