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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (1): 190-195. doi: 10.19723/j.issn.1671-167X.2026.01.025

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Analysis of early complications and risk factors in patients with amyotrophic lateral sclerosis after percutaneous endoscopic gastrostomy

Xueli TIAN1, Zhiqiang SONG1, Yonghui HUANG2,*(), Wei YAO1   

  1. 1. Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
  • Received:2025-05-26 Online:2026-02-18 Published:2025-08-27
  • Contact: Yonghui HUANG

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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).

Key words: Amyotrophic lateral sclerosis, Gastrostomy, Factor analysis, statistical, Complications

CLC Number: 

  • R744.8

Figure 1

Percutaneous endoscopic gastrostomy (PEG) using the pull technique A, puncture needle with plastic sheath into abdominal and gastric walls; B, the needle was removed and the guide wire was inserted through the plastic sheath; C, biopsy forceps grasping guidewire through the endoscopic channel; D, PEG tube was placed by the pull technique using an internal bumper."

Table 1

Complications after PEG tube placement within 14 days"

Complications within 14 days n
Minor complications
  Post-operative fever (prophylactic antibiotics) 27
    Without evident infection 16
    Respiratory tract infection 7
    Peristomal wound infection 4
  Tube dislodgement 0
  Benign pneumoperitoneum 0
Major complications
  Post-operative fever (upgraded antibiotics)) 13a
    Respiratory tract infection 11a
    Peristomal wound infection 2
  Hemorrhage 0
  Injury to internal organs 0
  Buried bumper syndrome 0
  Respiratory failure 2a
  Death 2a

Table 2

Descriptive statistics and bivariate comparisons of patients who had complication vs. non-complication"

Items Complication (n=46) Non-complication (n=146) Statistics (χ2/t/z) P
Male, n (%) 25 (54) 72 (49) 0.354 0.552
Site of disease onset (bulbar), n (%) 21 (46) 72 (49) 0.188 0.665
Age at disease onset /years, $\bar x \pm s$ 54±11 56±12 0.897 0.572
Diagnose delay/months, M (P25, P75) 12 (7, 18) 12 (6, 24) －0.192 0.848
ALSFRS, $\bar x \pm s$ 24±10 24±10 －0.247 0.805
Interval from disease onset to PEG/months, M (P25, P75) 25 (17, 39) 26 (18, 40) －0.329 0.742
Laboratory data, $\bar x \pm s$
  Albumin/(g/L) 41.5±4.1 41.2±3.2 0.512 0.610
  Creatinine/(μmol/L) 61.0±18.6 60.0±18.0 0.327 0.744
  Sodium/(mmol/L) 140.5±2.4 139.9±8.9 0.388 0.698
  Potassium/(mmol/L) 3.8±0.3 3.9±0.3 －1.247 0.214
  Triglyceride/(mmol/L) 1.5±0.7 1.3±0.6 1.442 0.223
Transnasal gastroscopy, n (%) 34 (73) 107 (73) 0.007 0.933
Operation time/min, $\bar x \pm s$ 16±5 13±5 3.606 0.000
Hospital days, M(P25, P75) 6 (5, 9) 5 (3, 7) 2.692 0.009

Table 3

Descriptive statistics and bivariate comparison of patients who had minor complication vs. major complication"

Items Minor complication (n=33) Major complication (n=13) Statistics (χ2/t/z) P
Male, n (%) 20 (61) 5 (39) 1.843 0.175
Site of disease onset (bulbar), n (%) 18 (55) 3 (23) 3.722 0.054
Age at disease onset/years，$\bar x \pm s$ 56±12 51±10 1.368 0.178
Diagnose delay (months), M (P25, P75) 12 (9, 20) 11 (5, 18) -0.880 0.379
ALSFRS，$\bar x \pm s$ 25±10 23±11 0.438 0.664
Interval from disease onset to PEG/months, M (P25, P75) 25 (15, 35) 25(19, 65) －1.000 0.317
Laboratory data, $\bar x \pm s$
  Albumin/(g/L) 42.2±3.3 39.6±5.4 1.915 0.062
  Creatinine/(μmol/L) 66.8±16.4 46.5±16.2 3.788 0.000
  Sodium/(mmol/L) 140.7±2.6 139.9±1.7 1.004 0.321
  Potassium/(mmol/L) 3.8±0.3 3.9±0.4 －0.889 0.379
  Triglyceride/(mmol/L) 1.6±0.7 1.1±0.5 2.148 0.038
Transnasal gastroscopy, n (%) 24 (73) 10 (77) N/A >0.999
Operation time/min, $\bar x \pm s$ 15±5 20±5 －3.336 0.002
Hospital days, M(P25, P75) 6 (5, 8) 5 (4, 14) －0.841 0.400

Table 4

Multivariate analysis of risk factors related complications"

Predictors OR 95%CI P
Site of disease onset 0.889 0.406－1.946 0.769
Albumin 1.020 0.907－1.146 0.743
Creatinine 0.727 0.975－1.018 0.727
Triglyceride 1.453 0.834－2.532 0.187
Operation time 1.132 1.051－1.220 0.001
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