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What is Endoscopic Gastrostomy in ALS?

Amyotrophic Lateral Sclerosis (ALS) is a degenerative pathology that affects the neurological system and produces motor disorders that progress to paralysis. 

ALS patients can develop other diseases such as dysphagia and require nutritional support through a nasogastric tube or Percutaneous Endoscopic Gastrostomy (PEG), which significantly increases their survival.

PEG is a technique in which a hole is made in the anterior wall of the abdomen to insert a feeding tube directly into the stomach. 

This procedure is used in cases where the patient suffers from prolonged malnutrition. It prevents usual complications of the nasogastric tube such as obstruction, frequent replacements, and the impossibility of placement due to esophageal stenosis.

Why is it done?

PEG is performed to increase the survival of ALS patients and improve their quality of life. Through an enteral tube, a direct entrance to the stomach is created to administer food, liquids, and medications and thus combat the malnutrition suffered by these patients due to, in many cases, not being able to swallow on their own.

It is an excellent alternative to the nasogastric tube since it avoids many of its complications, can be handled in a simple, helpful, and quick way, and can be maintained for an extended period.

What does it consist of?

It is a procedure that generally does not require general anesthesia and is applied in a few minutes. The abdominal wall is located through an endoscopy, the skin is disinfected, and the abdominal wall is anesthetized. 

Next, an incision of approximately one centimeter is made, and a trocar is inserted until the stomach’s interior can be visualized. Subsequently, a guide is injected with a clamp and dragged to the patient’s mouth while the endoscope is withdrawn. 

The probe is attached to the guide and, pulling the other end of the guide. It is passed through the mouth until it exits through the abdominal incision, where it is held in place by a fixation. Tube feeding can be started 24 hours after placement, and the stoma will heal in about two weeks.

Preparation for Endoscopic Gastrostomy in ALS

Patients undergoing PEG should not eat for two hours before catheterization. From there, it will not be necessary to follow other specific instructions to proceed with applying this technique.

Care after the intervention

Although it is a novel technique that eliminates most of the risks associated with the nasogastric tube, it requires some care after its application.

It should be checked that there is no skin irritation, redness, inflammation, or discharge regarding the stoma. If symptoms such as fever, weight loss, or diarrhea, among others, occur, it is necessary to see a specialist. 

The stoma should also be cleaned with an antiseptic solution for the first 15 days and then washed with soap and water. It is a procedure to be performed daily.

The catheter requires washing before and after the administration of food and drugs, and it is important to rotate it every 24 hours to prevent it from sticking to the skin and check that the external support does not oppress it. It is also advisable to cover it after use and be careful not to pinch, clamp or bend it.

For central nutrition administration, the patient must be sitting or semi-sitting. Care must be taken not to administer medication and food together. 

The open nutritional preparation should not be kept in the refrigerator for more than 24 hours and removed between 30 and 45 minutes before administration.

Alternatives to this treatment

It is a novel procedure that allows combating the nasogastric tube’s risks. It also offers an accessible mode of use, which means much more comfort for the patient and the Nursing specialist in charge of their care.

Currently, PEG represents a significant advance in increasing the survival and quality of life of patients with ALS.


Paul Petersen