Percutaneous endoscopic gastrostomy using 10-cc syringe tubes for amyotrophic lateral sclerosis patients with limited mouth opening

Abstract

Percutaneous endoscopic gastrostomy (PEG) is the most common method of delivering long-term enteral feeding to patients who are unable to take adequate nutrition by mouth [1]. We sometimes encounter patients for whom it is difficult to install the mouthpiece because of limitations of their mouth opening, such as in patients with neuromuscular disorders. In such cases we had tried transnasal insertion of the PEG, nasogastric feeding, or laparoscopic gastrostomy tube placement [2] [3] [4]. However, transoral insertion of PEG has many advantages over the other procedures [2] [3] [4] [5]. For that reason, we tested the feasibility of using a 10-cc syringe instead of a conventional mouthpiece during PEG in patients with limited mouth opening.A total of 12 cases (7 women, 5 men; mean age 63.5 years old) were enrolled from September 2010 to September 2011. All were patients with amyotrophic lateral sclerosis (ALS) and limited mouth opening. The 10-cc syringe was cut to a length of 4.5 cm with a compass saw, and the cut surface (1.5 cm wide) was smoothed with sandpaper ([Fig. 1]). PEG was performed using a standard upper endoscope (GF-260; Olympus, Tokyo, Japan) and gastrostomy set (PEG-24-PULL-S; Cook Medical, Bloomington, Indiana, USA).