Document Detail


Radiologic versus endoscopic placement of percutaneous gastrostomy in amyotrophic lateral sclerosis: multivariate analysis of tolerance, efficacy, and survival.
MedLine Citation:
PMID:  20172742     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare percutaneous radiologic gastrostomy (PRG) and percutaneous endoscopic gastrostomy (PEG) in terms of tolerance, efficacy, and survival in patients with amyotrophic lateral sclerosis (ALS). MATERIALS AND METHODS: Forty patients with ALS (17 men; mean age, 66.1 years; range, 39-83 y) underwent 21 PEG and 22 PRG attempts (including three unsuccessful PEG attempts) from 1999 to 2005. To assess tolerance and efficacy, a successful and well tolerated placement was defined as any successful placement with no major or minor local complications or pain requiring opioid analgesic agents. Univariate analysis was performed for all recorded parameters, followed by multivariate analysis for successful and well tolerated placement, 6-month mortality rate, and survival. RESULTS: General success rates were 85.7% for PEG and 100% for PRG. Pain was more frequent in PRGs (81.8% vs 52.4%; P = .05). Successful and well tolerated placement was seen in 81.8% of PRGs and 57.1% of PEGs (P = 0.1). Advanced age (P = .02) and PRG (P = .07) were predictive of successful and well tolerated placement. The interval from diagnosis to placement (P = .001) and ability to perform spirometry (P = .002) were predictive of survival. Oximetry measurements (P = .007) and interval from diagnosis to placement (P = .02) were predictive of mortality at 6 months. CONCLUSIONS: PRG is more efficacious and better tolerated than PEG, essentially because it avoids the respiratory decompensation that may occur in PEG. Therefore, PRG should be preferred in cases of ALS. Survival is linked to ALS evolution and not to the choice of PRG or PEG placement.
Authors:
Alexandre Blondet; Jérôme Lebigot; Guillaume Nicolas; Jérôme Boursier; Bruno Person; Laurent Laccoureye; Christophe Aubé
Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article     Date:  2010-02-20
Journal Detail:
Title:  Journal of vascular and interventional radiology : JVIR     Volume:  21     ISSN:  1535-7732     ISO Abbreviation:  J Vasc Interv Radiol     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-29     Completed Date:  2010-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203369     Medline TA:  J Vasc Interv Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  527-33     Citation Subset:  IM    
Copyright Information:
Copyright 2010 SIR. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Radiology, Centre Hospitalier Universitaire Angers, 4, rue Larrey, Angers Cedex 09, F-49933 France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Amyotrophic Lateral Sclerosis / diagnosis*,  mortality,  surgery*
Endoscopy / mortality*
Female
France
Gastrostomy / methods,  mortality*
Humans
Male
Middle Aged
Prevalence
Radiography, Interventional / mortality*
Risk Assessment
Risk Factors
Surgery, Computer-Assisted / mortality
Survival Analysis
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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