Mortality and Complications of Percutaneous Gastrostomy in Amyotrophic Lateral Sclerosis Patients

ABSTRACT Background: Installation of a percutaneous gastrostomy tube is often needed for patients with amyotrophic lateral sclerosis (ALS) who develop severe dysphagia. However, there is uncertainty regarding the optimal timing for this procedure, especially with regard to the decline in respiratory function. Several guidelines suggest that gastrostomy should be placed before the forced vital capacity (FVC) drops below 50%, since the procedural risks are heightened. However, multiple studies argue that this procedure could be safe in patients with an FVC of less than 50%. Methods: In this retrospective study, we reviewed the medical records of all patients with ALS who had a gastrostomy at our center between 2010 and 2023. Our primary objective was to identify the 30-day mortality rate and the incidence of complications after this procedure. Also, we investigated whether predictive factors of adverse outcomes could be identified, particularly to evaluate if there was an association with pulmonary function. Results: We included 54 patients. The 30-day mortality rate was 9.3%, and the incidence of major complications was 16.7%. There was no statistical difference in complications between percutaneous endoscopic and radiologically inserted gastrostomy procedures. Predictive factors for complications were pre-existing pulmonary disease, pre-procedural CO 2 levels and, although not statistically significant, diabetes. There was no association between FVC and the occurrence of adverse outcomes, although only 70% of patients had a measure of pulmonary function. Conclusion: In our study, there was no correlation between FVC and the occurrence of adverse events from the gastrostomy procedure. This suggests that the traditional cutoff of 50% FVC level should be re-examined and explored further in future studies.