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Shah A, Busch RA, Koepsel EK, Eisa M, Woods M, Palchaudhuri S. Who Places Feeding Tubes and in What Scenario? Curr Gastroenterol Rep 2023:10.1007/s11894-023-00880-x. [PMID: 37452152 DOI: 10.1007/s11894-023-00880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE OF REVIEW Enteral feeding is commonly used to provide patients with nutrition. Access via feeding tubes can be attained by multiple medical specialties through a variety of methods. RECENT FINDINGS There are limited data available on direct comparisons amongst gastroenterologist, interventional radiologists and surgeons, although there appears to be similar rates of complications. Fluroscopically and surgically placed feeding tubes may have a higher technical success rate than endoscopically placed tubes. The preferred specialty for feeding tube placement varies per institution, often due to logistical matters over technique or concern for complications. Ideally, a multidisciplinary team should exist to determine which approach is best in a patient-specific manner.
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Affiliation(s)
- Apeksha Shah
- Division of Gastroenterology and Hepatology, Cooper University Healthcare, Camden, NJ, USA.
- Division of Gastroenterology, Cooper Medial School of Rowan University (CMSRU), Cooper University Hospital, Camden, NJ, USA.
| | - Rebecca A Busch
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Erica Knavel Koepsel
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Mohamed Eisa
- Allegheny Center for Digestive Health, Allegheny Health Network, Pittsburgh, PA, USA
| | - Michael Woods
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sonali Palchaudhuri
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
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Outcomes of Bariatric Surgery Before, During, and After Solid Organ Transplantation. Obes Surg 2022; 32:3821-3829. [DOI: 10.1007/s11695-022-06334-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
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Patel NR, Bailey S, Tai E, Mirrahimi A, Mafeld S, Beecroft JR, Tan KT, Annamalai G. Randomized Controlled Trial of Percutaneous Radiologic Gastrostomy Performed With and Without Gastropexy: Technical Success, Patient-Reported Outcomes and Safety. Cardiovasc Intervent Radiol 2021; 44:1081-1088. [PMID: 33709271 DOI: 10.1007/s00270-021-02806-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/12/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of this study is to compare balloon-retention percutaneous radiologic gastrostomy (PRG) tube insertion performed with and without gastropexy, primarily focusing on pain and patient-reported outcomes. MATERIALS AND METHODS Research ethics board approved a dual-arm, single-centre, randomized trial of 60 patients undergoing primary 14-French PRG tube insertion (NCT04107974). Patients were randomized to receive either PRG with gastropexy or without gastropexy. Data were collected for technical outcomes, patient-reported outcomes pre-procedure, post-procedure and at 1-month, as well as quality of life parameters at 1-month post-procedure (EQ5D-5L, Visual Analogue Scale and Functional Assessment of Cancer Therapy-Enteral Feeding questionnaires). Complications occurring up to 6-months post-procedure were recorded. RESULTS Sixty patients were randomized to the gastropexy group (n = 30) or non-gastropexy (n = 30) group. One non-gastropexy patient was withdrawn from the study due to failed insertion. PRG procedural time was significantly longer when using gastropexy (mean 11.4 ± 7.19 min) compared with non-gastropexy (mean 6.79 ± 4.63 min; p < 0.05). Pain scores did not differ between the two groups pre-procedure, post-procedure and at 1-month follow-up, nor did 1-month quality of life parameters. Six (20%) minor complications occurred in the gastropexy group and nine (31%) minor complications in the non-gastropexy group (p = 0.330). Two (6.9%) major complications occurred in the non-gastropexy group (p = 0.458). CONCLUSION There is comparable patient tolerability when balloon-retention PRG insertion is performed with or without gastropexy sutures. This study also demonstrated a trend towards fewer complications when gastropexy is utilized. However, further larger trials are required to compare complications of the two approaches for PRG insertion. LEVEL OF EVIDENCE Level 2, randomized trial.
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Affiliation(s)
- Neeral R Patel
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada.
| | - Shawn Bailey
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Elizabeth Tai
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Arash Mirrahimi
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Sebastian Mafeld
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - J Robert Beecroft
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Kong Teng Tan
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Ganesan Annamalai
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
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Johnson DY, Gallo CJR, Agassi AM, Sag AA, Martin JG, Pabon-Ramos W, Ronald J, Suhocki PV, Smith TP, Kim CY. Percutaneous gastrojejunostomy tubes: Identification of predictors of retrograde jejunal limb migration into the stomach. Clin Imaging 2020; 70:93-96. [PMID: 33137642 DOI: 10.1016/j.clinimag.2020.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/30/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify whether technically modifiable factors during gastrojejunostomy (GJ) tube insertion are predictive of retrograde jejunal limb migration into the stomach. MATERIALS AND METHODS Retrospective review of our procedural database over a 5-year period revealed 988 successful primary GJ tube insertions. Medical records and imaging were reviewed for cases of retrograde jejunal limb migration. Primary analysis was performed on 74 patients with retrograde tip migration within 3 months after placement (37 males, mean age = 57). Comparison was performed on 67 control patients (34 males, mean age = 51) who had radiologically confirmed GJ tube stability for at least 6 months. Procedural fluoroscopic images were analyzed for multiple GJ tube configuration parameters. The stomach was designated into antrum, body, and fundus. Predictors of retrograde tip migration were analyzed with univariate and multivariate logistic regression analysis. RESULTS A total of 110 patients (11.1%) had retrograde jejunal limb migration, with 74 (7.5%) occurring within 3 months of placement. On multivariate analysis, the factors associated with a significantly lower risk of tip malposition included gastric puncture site in the antrum (OR: 0.27, 95% CI: 0.13-0.56, p < 0.001) and GJ tract angle less than 30 degrees away from the pylorus (OR: 0.35, 95% CI: 0.16-0.76, p = 0.008). No patient in either cohort had a major complication within 30 days of procedure. CONCLUSION To minimize the risk of retrograde tip migration, GJ tubes should be inserted into the gastric antrum with an entry tract oriented as directly towards the pylorus as possible.
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Affiliation(s)
- David Y Johnson
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America.
| | - Christopher J R Gallo
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Andre M Agassi
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Alan A Sag
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Jonathan G Martin
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Waleska Pabon-Ramos
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - James Ronald
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Paul V Suhocki
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Tony P Smith
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Charles Y Kim
- Division of Interventional Radiology, Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Durham, NC 27710, United States of America
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Cho SB, Kim HR, Jung EC, Chung HH, Lee SH, Park BJ, Sung DJ. The application of a vascular closure device for closing a gastrostomy opening used for procedural access. Br J Radiol 2019; 92:20180837. [PMID: 31150282 DOI: 10.1259/bjr.20180837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To study the feasibility of applying the Perclose ProGlide vascular closure device (PPVCD) in vitro for closing a gastrostomy opening for procedural access in the swine stomach in order to prevent peritoneal leakage. METHODS The study included four experimental groups: one manual suture (n = 10), two manual sutures (n = 10), one PPVCD suture (n = 10), and two PPVCD sutures (n = 5). In the two PPVCD sutures group, the "pre-close" technique was used. The leak pressure was measured, and statistical analysis was conducted to compare the leak pressures among the experimental groups. RESULTS The gastrostomy openings were successfully closed in all experimental groups. The median (range) values of leak pressure (mmHg) for each experimental group were as follows: one manual suture, 86.0 (75.0-110.0); two manual sutures, 98.5 (44.0-130.0); one PPVCD suture, 96.5 (56.0-119.0); and two PPVCD sutures, 98.0 (66.0-104.0). The Mann-Whitney U test revealed no statistically significant difference in leak pressure between the manual (n = 20) and PPVCD (n = 15) suture groups. The Kruskal-Wallis test revealed no statistically significant difference in leak pressure among the four experimental groups. The Bonferroni post hoc test also revealed no statistically significant difference in the pairwise comparisons among the groups. CONCLUSION Application of PPVCD is feasible for the closure of gastrostomy openings in an animal model and is as effective as a manual suture. ADVANCES IN KNOWLEDGE In our in vitro study, percutaneous closure of gastrostomy opening using PPVCD was possible; animal survival studies and development of specific devices are needed before clinical application.
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Affiliation(s)
- Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, Inchon-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Hyoung Rae Kim
- Department of Radiology, Gimpo Woori Hospital, Gamam-ro, Gimpo-si, Gyeonggi-do, Republic of Korea
| | - Eui-Chul Jung
- Department of Radiology, Nowon Eulji Medical center, Eulji University, Hangeulbiseok-ro, Nowon-gu, Seoul, Republic of Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University Ansan Hospital, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Beom Jin Park
- Department of Radiology, Korea University Anam Hospital, Inchon-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Deuk Jae Sung
- Department of Radiology, Korea University Anam Hospital, Inchon-ro, Seongbuk-gu, Seoul, Republic of Korea
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