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Published online before print September 30, 2004, 10.1148/radiol.2332031487
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(Radiology 2004;233:392-399.)
© RSNA, 2004

Vascular and Interventional Radiology

Entristar Skin-Level Gastrostomy Tube: Primary Placement with Radiologic Guidance in Patients with Amyotrophic Lateral Sclerosis1

Ashley S. Shaw, MB, FRCR, Mary A. Ampong, RN, Alan Rio, BSc, Jean McClure, RN, P. Nigel Leigh, PhD, FRCP and Paul S. Sidhu, MB, FRCR

1 From the Departments of Radiology (A.S.S., J.M., P.S.S.), Neurosciences (M.A.A.), and Dietetics (A.R.), King’s College Hospital, Denmark Hill, London SE5 9RS, England; and Department of Neurology, King’s MND Care & Research Centre, London, England (P.N.L.). Received September 15, 2003; revision requested November 28; revision received January 26, 2004; accepted February 17. Address correspondence to P.S.S. (e-mail: paul.sidhu@kingsch.nhs.uk).

PURPOSE: To retrospectively review the authors’ experience with a radiologic method of primary insertion of a skin-level gastrostomy tube (Entristar; Tyco Healthcare, Mansfield, Mass) in patients with amyotrophic lateral sclerosis (ALS).

MATERIALS AND METHODS: Over a 12-month period (September 2002 through September 2003), 25 patients with ALS (mean age, 62.4 years; age range, 41–83 years; 15 men, 10 women) who had bulbar impairment and a body mass index of less than 20 kg/m2 or weight loss of greater than 10% were selected for placement of an enteral feeding tube. Patients with overnight oxygen desaturation or respiratory acidosis were referred for placement of the Entristar tube with radiologic guidance. This procedure was performed with local anesthesia and without sedation by using a modified percutaneous lateral fluoroscopic technique that aided tube insertion in patients with elevation of the hemidiaphragm and a "high" stomach position. Technical success and immediate and delayed procedure complications were recorded.

RESULTS: The Entristar tube was successfully inserted in all 25 patients. Pneumoperitoneum as an early complication was documented in one patient, and one patient developed a pelvic abscess that required drainage. Follow-up for a median of 112 days (range, 14–343 days) revealed superficial wound infections in four patients and weight gain in two patients; weight gain necessitated tube replacement in one patient. There were no procedure-related deaths.

CONCLUSION: Radiologically guided insertion of the Entristar skin-level gastrostomy tube is a safe procedure in patients with ALS that allows the creation of a permanent feeding gastrostomy without the need for sedation or endoscopy.

© RSNA, 2004

Index terms: Amyotrophic lateral sclerosis, 10.87, 30.87 • Gastrointestinal tract, radiography, 72.1267 • Gastrostomy, 72.1267 • Stomach, interventional procedures, 72.1267