Abstract
OBJECTIVE: To explore risk factors of early complications (≤14 days) and the clinical characteristics in patients with amyotrophic lateral sclerosis (ALS) after percutaneous endoscopic gastrostomy (PEG). METHODS: Patients diagnosed with ALS who underwent first PEG insertion between January 2011 and December 2020 were eligible. Medical records were retrospectively reviewed to determine clinical characteristics and outcomes (≤14 days) of patients who underwent the pull type PEG. Grouping was performed based on the presence and severity of complications, and SPSS 27.0 statistical software was used for data analysis. Finally, Logistic regression model was applied for multivariate factor analysis of risk factors related to complications. RESULTS: In the study, 192 cases of PEG were all successfully completed, with 97 (51%) males, mean age of ALS onset disease (55±11) years and 93 (48%) bulbar onset symptoms included. Complications occurred in 40 (21%) cases after PEG within 14 days, all of which had fever, including 16 cases without clear infection focus, 18 cases of respiratory tract infections, and 6 cases of fistula site infections. In the study, 13 (7%) cases had major complications, including 11 cases of respiratory tract infection and 2 cases of stoma infection. Two cases of respiratory tract infection died due to respiratory failure, and the remaining 11 cases recovered after upgraded antibiotic. No complications, such as tube dislodgement, benign pneumoperitoneum, hemorrhage or buried bumper syndrome occurred. The operation time and postoperative hospital stay were longer in the complication group than in the non-complication group [(16±5) min vs. (13±5) min, P < 0.001; 6 (5, 9) d vs. 5 (3, 7) d, P=0.009]. Compared with the mild complication group, the creatinine and triglyceride in the major complication group were significantly lower [(46.5±16.2) μmol/L vs.(66.8±16.4) μmol/L, P＜0.001; (1.1±0.5) mmol/L vs.(1.6±0.7) mmol/L, P=0.038], and the operation time was significantly longer [(20±5) min vs. (15±5) min, P=0.002]. Further, Logistic regression model analysis revealed that the operation time was also independent associated with complications (OR=1.132, 95%CI: 1.051-1.220, P=0.001). CONCLUSION: PEG was a reliable method for ALS patients to put nutrition tube. Postoperative fever was the most common complications. Long surgical duration was an independent risk factor for the occurrence of complications (≤14 d).