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. Patients with ALS may develop other diseases such as dysphagia and will require nutritional support through a nasogastric tube or a Percutaneous Endoscopic Gastrostomy (PEG), which significantly increases their survival.
PEG is a technique in which an opening is made in the anterior wall of the abdomen to introduce a feeding tube directly into the stomach. This procedure is used in cases in which the patient suffers from prolonged malnutrition, since it prevents the usual complications of the nasogastric tube such as obstruction, frequent replacements and impossibility of placement due to stenosophageal stenosis.
Why is it performed?
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 a good alternative to the nasogastric tube since it avoids many of its complications and can be managed in a simple, useful and fast way and can be maintained for a long period of time.
What does it consist of?
It is a procedure that generally does not require general anesthesia and is performed in a few minutes. By means of an endoscopy the abdominal wall is located, the skin is disinfected and the abdominal wall is anesthetized. Then an incision of approximately one centimeter is made and a trocar is introduced until the inside of the stomach can be visualized. A guidewire is then injected, held in place with a clamp and pulled into the patient’s mouth at the same time as the endoscope is removed. The tube is attached to the guidewire and, by pulling the other end of the guidewire, it is passed through the mouth until it exits through the abdominal incision, where it is held in place by a clamp. Feeding through the tube can be started within 24 hours of placement and the stoma will heal in about two weeks.
PEG improves survival and quality of life in ALS patients.
Preparing for Endoscopic Gastrostomy in ALS
Patients undergoing PEG should not eat for two hours prior to the application of the probe. Thereafter, it will not be necessary to follow other specific indications to proceed with the application of this technique.
Post-procedure care
Although it is a novel technique that allows to put an end to most of the risks that the nasogastric tube entails, it is true that it is necessary to take into account that it requires some care after its application.
Regarding the stoma, it is important to check that there is no skin irritation, redness, inflammation or secretion. If symptoms such as fever, weight loss or diarrhea, among others, occur, a specialist should be consulted. The stoma should also be cleaned with an antiseptic solution for the first 15 days and then washed with soap and water. This procedure should be performed daily.
The tube requires washing before and after the administration of food and drugs and it is important to turn it every 24 hours to prevent it from adhering to the skin and to check that the external support does not press it. It is also advisable to cover it after use and to be careful not to pinch, pinch or bend it.
For the administration of enteral nutrition the patient should be seated or semi-seated. Care should be taken not to administer medication and food together and the nutritional preparation should not be kept open for more than 24 hours in the refrigerator and should be removed 30 to 45 minutes before administration.
Alternatives to this treatment
This is a novel procedure that allows to combat the risks that the nasogastric tube can develop. It also offers an easy mode of use, which is much more convenient for the patient and for the nursing specialist in charge of the patient’s care.
Currently, the PEG is a breakthrough in increasing survival and quality of life for ALS patients.