Safety of Gastrostomy Tube Placement in Advanced ALS Patients with Non‐invasive Ventilation

BACKGROUND In patients with amyotrophic lateral sclerosis (ALS), bulbar muscle dysfunction can occur, which eventually requires the initiation of enteral tube feeding. However, there is no consensus on the optimal timing for the gastrostomy nor proper ventilator support method during the procedure. We aimed to investigate the safe range of gastrostomy according to respiratory support status and forced vital capacity (FVC) % of predicted values classification, and to compare the safety of non-invasive and invasive mechanical ventilation during the procedure in ALS patients with FVC < 30% of predicted. METHODS A total of 477 patients diagnosed with ALS at our institution from January 1, 2009 to December 31, 2018, were evaluated, and finally 105 patients were enrolled in this study. All medical records covering ventilation status and complications within six months to one year after the initial gastrostomy were gathered and reviewed. RESULTS The gastrostomy procedure was considered safe regardless of FVC status or modality of respiratory support. There were complications related to the gastrostomy procedure in six of 105 patients and all were managed through conservative care. The incidence of complications, including respiratory ones, for non-invasive and invasive positive pressure ventilation was 5.5% and 9.6%, respectively, which were not statistically significantly different (P = 0.294). CONCLUSION The procedure and tube placement of a gastrostomy can be safely performed in ALS patients with minimal FVC regardless of ventilation invasiveness. We suggest that there should be new standard for FVC % of predicted to facilitate performing gastrostomy in ALS patients. This article is protected by copyright. All rights reserved.