Name of the Procedure:

Nutritional Support for Amyotrophic Lateral Sclerosis (ALS)

Summary

Nutritional support for ALS involves various methods to ensure patients receive adequate nutrition as the disease progresses and impacts their ability to eat and swallow. This support can include dietary modifications, supplements, and sometimes feeding tube insertion.

Purpose

The procedure addresses malnutrition and weight loss in patients with ALS. Proper nutritional support aims to maintain muscle mass, improve quality of life, and potentially slow the disease's progression by ensuring the body gets the nutrients it needs.

Indications

• Significant weight loss or inability to maintain a healthy weight.
• Difficulty swallowing or chewing food (dysphagia).
• Fatigue and weakness making meal preparation and consumption challenging.

Preparation

• Consultation with a dietitian to devise an appropriate meal plan.
• Swallowing assessment by a speech-language pathologist.
• For feeding tube insertion: fasting prior to the procedure and preoperative assessments like blood tests.

Procedure Description

Nutritional support may include:

1. Dietary Modifications: Soft or pureed foods, high-calorie and high-protein meals.
2. Supplements: High-calorie drinks and vitamin/mineral supplements.
3. Feeding Tube Insertion: A percutaneous endoscopic gastrostomy (PEG) tube is placed under sedation. This involves creating a small incision in the abdomen and using an endoscope to guide the tube into the stomach for direct feeding.

Duration

Dietary consultations and assessments typically last 1-2 hours. Feeding tube insertion usually takes about 30-45 minutes.

Setting

Dietary consultations and swallow studies may be conducted in outpatient clinics. Feeding tube insertion is performed in a hospital or surgical center.

Personnel

• Registered Dietitian
• Speech-Language Pathologist
• Gastroenterologist or Surgeon
• Anesthesiologist
• Nursing Staff

Risks and Complications

• Dietary changes: May cause gastrointestinal discomfort initially.
• Feeding tube insertion: Infection, bleeding, tube displacement, or blockage.
• Proper management of complications includes antibiotics for infections and adjustments or replacements of feeding tubes if issues arise.

Benefits

• Prevents malnutrition and maintains body weight.
• Enhances energy levels and overall physical function.
• Improves quality of life.

Recovery

• After feeding tube insertion, patients typically recover within a few days.
• Instructions may include wound care, tube cleaning, and signs of infections to watch for.
• Follow-up appointments for dietary management and tube maintenance.

Alternatives

• Continued oral feeding with modifications.
• Non-invasive methods like specialized utensils and feeding strategies.
• Pros of alternatives include less invasive options and retaining normal eating experiences. Cons include potential insufficient nutrient intake and risk of aspiration pneumonia.

Patient Experience

Patients might experience anxiety about changing dietary habits or tube insertion. During diet consultations, there is generally no pain, but feeding tube insertion involves mild discomfort and recovery from sedation. Pain management measures and supportive care are provided to ensure comfort during and after the procedure.