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Proactive approach: As symptoms progress especially for patients whose intake is compromised (including dysphagia and respiratory function changes), a feeding tube may be indicated.
Earlier g-tube insertion likely leads to a less risky procedure and will provide an easier to transition from oral intake to enteral feeds as ALS progresses.
Shoesmith, C., Abrahao, A., Benstead, T., Chum, M., Dupre, N., Izenberg, A., ... & Zinman, L. (2020). Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ, 192 (46), E1453-E1468. 
There is greater risk associated with gastrostomy feeding tube placement with a FVC <50%.
Based on respiratory status, the patient may be deemed appropriate for inpatient (hospital admission stay can be 1week+) or outpatient (day procedure). Inpatient procedures can be scheduled in advance or patients may have to go to their local emergency department if needed.
For more information, see Nutrition Assessment Considerations.
Feeding Tube Placement Procedure – Gastrostomy Tube #
Performed by a gastroenterologist (acute care setting) or a radiologist (via Interventional Radiology, less invasive).
Methods #
- PEG (Percutaneous Endoscopic Gastrostomy) – which is inserted via a telescope down the food pipe.
- RIG (Radiologically Inserted Gastrostomy)- which is inserted using X-ray guidance following barium place inside the stomach.
Types #
- Standard g-tube or Low-Profile MIC-Key feeding tubes (most common types inserted).
For information on the process (more detail) please refer to ALS Canada Feeding Tube Fact Sheet .
https://www.ouh.nhs.uk/services/departments/neurosciences/neurology/mnd/support/peg-rig.aspx
LHIN/CCAC Arrangements #
Arrangements are to be made by ALS Clinic RD or inpatient RD (if patient is admitted for feeding tube insertion) for RN Day of procedure (if outpatient) or discharge (if patient was admitted for feeding tube insertion). Supports also need to be arranged for an RD day after procedure (if outpatient) or discharge (if patient was admitted for feeding tube insertion). The RN and RD should be following the patient on a consistent basis for as long as needed.
Patients under 65 years old require (1) CCAC drug card and (2) Assistance with forms to help provide funding when CCAC not following.
Sources and Further Reading
#
- Shoesmith, C., Abrahao, A., Benstead, T., Chum, M., Dupre, N., Izenberg, A., … & Zinman, L. (2020). Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ, 192(46), E1453-E1468.
