{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:31:17Z","timestamp":1747186277013,"version":"3.40.5"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,4,25]],"date-time":"2022-04-25T00:00:00Z","timestamp":1650844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Percutaneous endoscopic gastrostomy (PEG) placement is recommended in patients with amyotrophic lateral sclerosis (ALS), but the procedure is considered high risk. In this study, we aimed to compare the outcome of ALS patients with and without PEG. The success of the procedure and complications of PEG insertion were also explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with ALS who met the criteria for enteral feeding support were consecutively recruited. Patients who consented had PEG insertion using the modified technique of introducer method with transoral ultra\u2010slim endoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 64 patients were recruited, of which 36 (56%) patients consented to PEG. The median age of all patients was 65\u00a0years and 59% were male. There was no difference in demographic and clinical characteristics between patients who agreed to a PEG and those who did not. The mortality rate at 6 and 12\u00a0months was lower in the PEG cohort compared with non\u2010PEG, but this was not statistically significant (6\u00a0months: 28.6% <jats:italic>vs<\/jats:italic> 32.2%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.561; 12\u00a0months: 38.9% <jats:italic>vs<\/jats:italic> 50.0%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.374). Amongst the PEG cohort, 61% were stratified high risk and 31% moderate risk. Thirty\u2010one percent of them required long\u2010term home noninvasive ventilation. All patients (100%) underwent successful PEG insertion at single attempt using the modified approach. The complications reported over a period of 6\u00a0months were infected PEG site (17%), dislodged gastrostomy tube (14%), and minor bleeding (8%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In ALS patients with moderate to high risk of PEG insertion, the introducer technique utilizing ultra\u2010slim endoscopy guidance was well tolerated and safe.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.15870","type":"journal-article","created":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T06:03:57Z","timestamp":1650953037000},"page":"1367-1372","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous endoscopic gastrostomy using the introducer method with ultra\u2010slim endoscopy in amyotrophic lateral sclerosis patients with respiratory compromise: A safe technique"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9811-7546","authenticated-orcid":false,"given":"Kee Huat","family":"Chuah","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn Chue Wai","family":"Yim","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur Adilah","family":"Abdul Aziz","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Medicine, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ee Chin","family":"Loh","sequence":"additional","affiliation":[{"name":"Palliative Care Unit, Department of Medicine, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Paul","family":"Capelle","sequence":"additional","affiliation":[{"name":"Palliative Care Unit, Department of Medicine, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nortina","family":"Shahrizaila","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Medicine, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex Hwong Ruey","family":"Leow","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,25]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181bc0141"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20101331.2011.03501.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(15)00104\u20100"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i24.7739"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2020.1832121"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010018\u20108861\u20104"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2016.1274330"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.20524\/aog.2020.0517"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100042\u2010112587"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/146608200300079536"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2007.09.143"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci9090223"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0192243"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2008.0033"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nrl.2018.01.003"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.22288"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1179\/1476830514Y.0000000161"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro\u20102017\u2010100894"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.4318\/tjg.2011.0207"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2015.07.016"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v13.i6.906"}],"container-title":["Journal 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