• Jung Hyun Park, Seong-Woong Kang, Jong Yun Won, and Chang Wook Uhm.
• Department of Rehabilitation Medicine, Eulji University Hospital, Daejeon, Korea.
• Jpen Parenter Enter. 2010 Jul 1;34(4):421-5.

BackgroundThe purpose of this study was to evaluate the safety and usefulness of fluoroscopy-guided percutaneous gastrostomy (FPG) in patients with amyotrophic lateral sclerosis (ALS) using a large-profile gastrostomy tube accompanied by the pull technique. This procedure was done without an accompanying endoscopy or gastropexy.MethodsThirty-six patients with ALS underwent FPG using a large-profile gastrostomy tube accompanied by the pull technique. A 24 Fr pull-type tube was inserted under fluoroscopic guidance into the mouth and pulled to the upper-abdominal puncture site using a snare. The technical success rate, occurrence of complications, and clinical outcomes were evaluated.ResultsThe technical success rate was 100%. There were no procedure-related mortalities or respiratory complications. The mean forced vital capacity of the patients was 732 mL (17.7% of the normal predicted value). During the procedure, 16 patients required ventilator support by nasal mask or tracheostomy. The tube indwelling period ranged from 1 to 24 months (average, 9.3). During this period, all the tubes were maintained in a proper position. In 18 patients, the tube was exchanged after 6 months without any problems.ConclusionsThe FPG procedure using a 24 Fr tube and the pull technique shows a high rate of technical success. This procedure has a low risk for respiratory complications because endoscopic guidance is not needed. In addition, gastropexy is not required, which allows a large-profile catheter to be inserted during a single procedure.

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