Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique

Background and Aim Percutaneous endoscopic gastrostomy (PEG) placement is recommended in patients with amyotrophic lateral sclerosis (ALS), but the procedure is considered high risk. In this study, we aimed to compare the outcome of ALS patients with and without PEG. The success of the procedure and...

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Main Authors: Chuah, Kee Huat, Yim, Carolyn Chue Wai, Abdul Aziz, Nur Adilah, Loh, Ee Chin, Capelle, David Paul, Shahrizaila, Nortina, Leow, Alex Hwong Ruey
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Published: Wiley 2022
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Online Access:http://eprints.um.edu.my/42005/
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spelling my.um.eprints.420052023-10-20T02:44:05Z http://eprints.um.edu.my/42005/ Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique Chuah, Kee Huat Yim, Carolyn Chue Wai Abdul Aziz, Nur Adilah Loh, Ee Chin Capelle, David Paul Shahrizaila, Nortina Leow, Alex Hwong Ruey R Medicine (General) RC Internal medicine Background and Aim Percutaneous endoscopic gastrostomy (PEG) placement is recommended in patients with amyotrophic lateral sclerosis (ALS), but the procedure is considered high risk. In this study, we aimed to compare the outcome of ALS patients with and without PEG. The success of the procedure and complications of PEG insertion were also explored. Methods Patients with ALS who met the criteria for enteral feeding support were consecutively recruited. Patients who consented had PEG insertion using the modified technique of introducer method with transoral ultra-slim endoscopy. Results A total of 64 patients were recruited, of which 36 (56%) patients consented to PEG. The median age of all patients was 65 years and 59% were male. There was no difference in demographic and clinical characteristics between patients who agreed to a PEG and those who did not. The mortality rate at 6 and 12 months was lower in the PEG cohort compared with non-PEG, but this was not statistically significant (6 months: 28.6% vs 32.2%, P = 0.561; 12 months: 38.9% vs 50.0%, P = 0.374). Amongst the PEG cohort, 61% were stratified high risk and 31% moderate risk. Thirty-one percent of them required long-term home noninvasive ventilation. All patients (100%) underwent successful PEG insertion at single attempt using the modified approach. The complications reported over a period of 6 months were infected PEG site (17%), dislodged gastrostomy tube (14%), and minor bleeding (8%). Conclusion In ALS patients with moderate to high risk of PEG insertion, the introducer technique utilizing ultra-slim endoscopy guidance was well tolerated and safe. Wiley 2022-07 Article PeerReviewed Chuah, Kee Huat and Yim, Carolyn Chue Wai and Abdul Aziz, Nur Adilah and Loh, Ee Chin and Capelle, David Paul and Shahrizaila, Nortina and Leow, Alex Hwong Ruey (2022) Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique. Journal of Gastroenterology and Hepatology, 37 (7, SI). pp. 1367-1372. ISSN 0815-9319, DOI https://doi.org/10.1111/jgh.15870 <https://doi.org/10.1111/jgh.15870>. 10.1111/jgh.15870
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine (General)
RC Internal medicine
spellingShingle R Medicine (General)
RC Internal medicine
Chuah, Kee Huat
Yim, Carolyn Chue Wai
Abdul Aziz, Nur Adilah
Loh, Ee Chin
Capelle, David Paul
Shahrizaila, Nortina
Leow, Alex Hwong Ruey
Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique
description Background and Aim Percutaneous endoscopic gastrostomy (PEG) placement is recommended in patients with amyotrophic lateral sclerosis (ALS), but the procedure is considered high risk. In this study, we aimed to compare the outcome of ALS patients with and without PEG. The success of the procedure and complications of PEG insertion were also explored. Methods Patients with ALS who met the criteria for enteral feeding support were consecutively recruited. Patients who consented had PEG insertion using the modified technique of introducer method with transoral ultra-slim endoscopy. Results A total of 64 patients were recruited, of which 36 (56%) patients consented to PEG. The median age of all patients was 65 years and 59% were male. There was no difference in demographic and clinical characteristics between patients who agreed to a PEG and those who did not. The mortality rate at 6 and 12 months was lower in the PEG cohort compared with non-PEG, but this was not statistically significant (6 months: 28.6% vs 32.2%, P = 0.561; 12 months: 38.9% vs 50.0%, P = 0.374). Amongst the PEG cohort, 61% were stratified high risk and 31% moderate risk. Thirty-one percent of them required long-term home noninvasive ventilation. All patients (100%) underwent successful PEG insertion at single attempt using the modified approach. The complications reported over a period of 6 months were infected PEG site (17%), dislodged gastrostomy tube (14%), and minor bleeding (8%). Conclusion In ALS patients with moderate to high risk of PEG insertion, the introducer technique utilizing ultra-slim endoscopy guidance was well tolerated and safe.
format Article
author Chuah, Kee Huat
Yim, Carolyn Chue Wai
Abdul Aziz, Nur Adilah
Loh, Ee Chin
Capelle, David Paul
Shahrizaila, Nortina
Leow, Alex Hwong Ruey
author_facet Chuah, Kee Huat
Yim, Carolyn Chue Wai
Abdul Aziz, Nur Adilah
Loh, Ee Chin
Capelle, David Paul
Shahrizaila, Nortina
Leow, Alex Hwong Ruey
author_sort Chuah, Kee Huat
title Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique
title_short Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique
title_full Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique
title_fullStr Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique
title_full_unstemmed Percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique
title_sort percutaneous endoscopic gastrostomy using the introducer method with ultra-slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: a safe technique
publisher Wiley
publishDate 2022
url http://eprints.um.edu.my/42005/
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score 13.211869