| 제목 |
Feasibility of gastrostomy in amyotrophic lateral sclerosis patients with low forced vital capacity |
| 소속 |
Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease1, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Pulmonary Rehabilitation Center2, Severance Hospital, Yonsei University College of Medicine, Seoul, Department of Rehabilitation Medicine3 |
| 저자 |
Eunyoung Kim1,2*, Min Cheol Ha3, Won Ah Choi1,2, Seong-Woong Kang1,2† |
Introduction
In patients with amyotrophic lateral sclerosis (ALS), bulbar-innervated muscle impairment occurs therefore all patients requires enteral nutrition, eventually. But there is no definite consensus regarding the optimal timing of gastrostomy tube insertion and it is still controversial. The aim of this study is to investigate the safety of gastrostomy in a large number of advanced ALS patients with forced vital capacity less than 30% of predicted value (FVCpred) and, finally, to suggest a new standard of FVC in gastrostomy procedure.
Method
We evaluated a total 479 of patients who were diagnosed with ALS according to Revised El Escorial Criteria in our hospital between January 1, 2005 and December 31, 2017. 126 patients who underwent gastrostomy for the first time among those patients who had not undergone tracheostomy and under 30% of FVCpred. The medical charts were retrospectively analyzed for ventilation status, complications from gastrostomy tube insertion to the first tube change.
Result
The gastrostomy procedure was safe regardless of FVC status or respiratory support. There were complications related to the gastrostomy procedure in 7 of 126 patients and all were managed through conservative care. Comparing non-invasive intermittent positive pressure ventilation(NIPPV) to invasive positive pressure ventilation(IPPV), complications were seen in 5 of 106 patients (4.7%) and 9 of 104 patients (8.7%). There was no statistically significant difference between two groups(p=0.386). No respiratory complications were found in any patient.
Conclusion
Percutaneous placement of gastrostomy is safe, effective procedure and can be performed in the ALS patients who have low vital capacity (FVCpred<30%). This study shows that only with non-invasive respiratory support such as NIPPV or ambu-bagging, gastrostomy was performed without severe complications such as respiratory decompression in patients who did not undergo tracheostomy surgery. We suggest that there should be a new standard of FVC to allow performing gastrostomy for ALS patients. |
|
Figure 1. Flow chart of patients inclusion in this retrospective study.
Table 1. Baseline demographics and clinical characteristics
|
