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Piñar-Gutiérrez A, González-Gracia L, Vázquez Gutiérrez R, García-Rey S, Jiménez-Sánchez A, González-Navarro I, Tatay-Domínguez D, Garrancho-Domínguez P, Remón-Ruiz PJ, Martínez-Ortega AJ, Serrano-Aguayo P, Giménez-Andreu MD, García-Fernández FJ, Bozada-García JM, Nacarino-Mejías V, López-Iglesias Á, Pereira-Cunill JL, García-Luna PP. Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre. J Clin Med 2024; 13:1836. [PMID: 38610601 PMCID: PMC11012573 DOI: 10.3390/jcm13071836] [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: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Lucía González-Gracia
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Rocío Vázquez Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Silvia García-Rey
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Andrés Jiménez-Sánchez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Irene González-Navarro
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Dolores Tatay-Domínguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pilar Garrancho-Domínguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pablo J. Remón-Ruiz
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Antonio J. Martínez-Ortega
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pilar Serrano-Aguayo
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - María Dolores Giménez-Andreu
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | | | | | | | - Álvaro López-Iglesias
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain
| | - José Luis Pereira-Cunill
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pedro Pablo García-Luna
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
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Kucha P, Zorniak M, Szmit M, Lipczynski R, Wieszczy-Szczepanik P, Kapala A, Wojciechowska U, Didkowska J, Rupinski M, Olesinski T, Maj T, Regula J, Kaminski MF, Januszewicz W. To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients. United European Gastroenterol J 2023; 11:951-959. [PMID: 37948117 PMCID: PMC10720683 DOI: 10.1002/ueg2.12467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/21/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The peroral "pull" technique and the direct "push" procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull-PEG is generally recommended as the first-line modality, many oncological patients require a push-PEG approach to prevent tumor seeding or overcome tumor-related obstruction. OBJECTIVE We aimed to compare the efficacy and safety of both PEG procedures in cancer patients. METHODS We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30-day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG-related adverse events were analyzed using a multivariable Cox proportional-hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre-/current-/post-treatment), and type of PEG. RESULTS We included 1055 PEG procedures (58.7% push-PEG/41.4% pull-PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [±10.7] yrs.; 70.2% males; indication: head-and-neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the "push" technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR] = 2.9; 95% CI = 1.9-4.3, p < 0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30-day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio = 2.7, 95% CI = 1.0-7.2, p = 0.042). CONCLUSION The risk of major AEs was comparable between the push- and pull-PEG techniques in cancer patients. Due to frequent tube dislodgement in push-PEG, the pull technique may be more suitable for long-term feeding. Previous CRT increases the risk of major AEs, favoring early ("prophylactic") PEG placement when such treatment is expected.
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Affiliation(s)
- Piotr Kucha
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Michal Zorniak
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Mateusz Szmit
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Rafal Lipczynski
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Paulina Wieszczy-Szczepanik
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Aleksandra Kapala
- Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Urszula Wojciechowska
- Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Joanna Didkowska
- Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maciej Rupinski
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Olesinski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Maj
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jaroslaw Regula
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Wladyslaw Januszewicz
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Kohli DR, Smith C, Chaudhry O, Desai M, DePaolis D, Sharma P. Direct Percutaneous Endoscopic Gastrostomy Versus Radiological Gastrostomy in Patients Unable to Undergo Transoral Endoscopic Pull Gastrostomy. Dig Dis Sci 2023; 68:852-859. [PMID: 35708794 DOI: 10.1007/s10620-022-07569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/17/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS A subset of patients needing long-term enteral access are unable to undergo a conventional transoral "pull" percutaneous endoscopic gastrostomy (PEG). We assessed the safety and efficacy of an introducer-style endoscopic direct PEG (DPEG) and an interventional radiologist guided gastrostomy (IRG) among patients unable to undergo a pull PEG. METHODS In this single center, non-randomized, pilot study, patients unable to undergo a transoral Pull PEG were prospectively recruited for a DPEG during the index endoscopy. IRG procedures performed at our center served as the comparison group. The primary outcome was technical success and secondary outcomes included 30-day and 90-day all-cause mortality, procedure duration, dosage of medications, adverse events, and 30-day all-cause hospitalization. The Charlson comorbidity index was used to compare comorbidities. RESULTS A total of 47 patients (68.3 ± 7.13 years) underwent DPEG and 45 patients (68.6 ± 8.23 years) underwent IRG. The respective Charlson comorbidity scores were 6.37 ± 2 and 6.16 ± 1.72 (P = 0.59). Malignancies of the upper aerodigestive tract were the most common indications for DPEG and IRG (42 vs. 37; P = 0.38). The outcomes for DPEG and IRG were as follows: technical success: 96 vs. 98%; P = 1; 30-day all-cause mortality: 0 vs 15%, P < 0.01; 90-day all-cause mortality: 0 vs. 31%, P < 0.001; 30-day hospitalization: 19 vs. 38%; P = 0.06; procedure duration: 23.8 ± 1.39 vs. 29.5 ± 2.03 min, P = 0.02; midazolam dose: 4.5 ± 1.6 vs. 1.23 ± 0.6 mg; P < 0.001, and opiate dose: 105.6 ± 38.2 vs. 70.7 ± 34.5 µg, P < 0.001, respectively. Perforation of the colon during IRG was the sole serious adverse event. CONCLUSION DPEG is a safe and effective alternative to IRG in patients unable to undergo a conventional transoral pull PEG and may be considered as a primary modality for enteral support. CLINICALTRIALS gov Identifier: NCT04151030.
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Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA.
- Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, WA, USA.
| | - Craig Smith
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Omer Chaudhry
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Madhav Desai
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA
| | - Dion DePaolis
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA
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Piñar-Gutiérrez A, Serrano-Aguayo P, García-Rey S, Vázquez-Gutiérrez R, González-Navarro I, Tatay-Domínguez D, Garrancho-Domínguez P, Remón-Ruiz PJ, Martínez-Ortega AJ, Nacarino-Mejías V, Iglesias-López Á, Pereira-Cunill JL, García-Luna PP. Percutaneous Radiology Gastrostomy (PRG)-Associated Complications at a Tertiary Hospital over the Last 25 Years. Nutrients 2022; 14:nu14224838. [PMID: 36432521 PMCID: PMC9694556 DOI: 10.3390/nu14224838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/05/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to describe and compare the complications associated with different percutaneous radiologic gastrostomy (PRG) techniques. METHODS A retrospective and prospective observational study was conducted. Patients who underwent a PRG between 1995-2020 were included. TECHNIQUES A pigtail catheter was used until 2003, a balloon catheter without pexy was used between 2003-2009 and a balloon catheter with gastropexy was used between 2015-2021. For the comparison of proportions, X2 tests or Fisher's test were used when necessary. Univariate analysis was performed to study the risk factors for PRG-associated complications. RESULTS n = 330 (pigtail = 114, balloon-type without pexy = 28, balloon-type with pexy = 188). The most frequent indication was head and neck cancer. The number of patients with complications was 44 (38.5%), 11 (39.2%) and 54 (28,7%), respectively. There were seven (25%) cases of peritonitis in the balloon-type without-pexy group and 1 (0.5%) in the balloon-type with-pexy group, the latter being the only patient who died in the total number of patients (0.3%). Two (1%) patients of the balloon-type with-pexy group presented with gastrocolic fistula. The rest of the complications were minor. CONCLUSIONS The most frequent complications associated with the administration of enteral nutrition through PRG were minor and the implementation of the balloon-type technique with pexy has led to a decrease in them.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Pilar Serrano-Aguayo
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Silvia García-Rey
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Rocío Vázquez-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Irene González-Navarro
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Dolores Tatay-Domínguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | | | - Pablo J. Remón-Ruiz
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | | | - Verónica Nacarino-Mejías
- Servicio de Radiología, Unidad de Radiología Intervencionista, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Álvaro Iglesias-López
- Servicio de Radiología, Unidad de Radiología Intervencionista, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - José Luis Pereira-Cunill
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Correspondence:
| | - Pedro Pablo García-Luna
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
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Stenberg K, Eriksson A, Odensten C, Darehed D. Mortality and complications after percutaneous endoscopic gastrostomy: a retrospective multicentre study. BMC Gastroenterol 2022; 22:361. [PMID: 35902805 PMCID: PMC9335963 DOI: 10.1186/s12876-022-02429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) is the method of choice for patients in need of long-term nutritional support or gastric decompression. Although it is considered safe, complications and relatively high mortality rates have been reported. We aimed to identify risk factors for complications and mortality after PEG in routine healthcare. Methods This retrospective study included all adult patients who received a PEG between 2013 and 2019 in Region Norrbotten, Sweden.
Results 389 patients were included. The median age was 72 years, 176 (45%) were women and 281 (72%) patients received their PEG due to neurological disease. All-cause mortality was 15% at 30 days and 28% at 90 days. Malignancy as the indication for PEG was associated with increased mortality at 90 days (OR 4.41, 95% CI 2.20–8.88). Other factors significantly associated with increased mortality were older age, female sex, diabetes mellitus, heart failure, lower body mass index and higher C-reactive protein levels. Minor and major complications within 30 days occurred in 11% and 15% of the patients, respectively. Diabetes increased the risk of minor complications (OR 2.61, 95% CI 1.04–6.55), while those aged 75 + years were at an increased risk of major complications, compared to those younger than 65 years (OR 2.23, 95% CI 1.02–4.85). Conclusions The increased risk of death among women and patients with malignancy indicate that these patients could benefit from earlier referral for PEG. Additionally, we found that age, diabetes, heart failure, C-reactive protein and body mass index all impact the risk of adverse outcomes.
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Affiliation(s)
- K Stenberg
- Department of Surgery, Sunderby Hospital, Kirurgkliniken, Sunderby sjukhus, Sjukhusvägen 10, 954 42, Södra Sunderbyn, Sweden.
| | - A Eriksson
- Department of Surgery, Sunderby Hospital, Kirurgkliniken, Sunderby sjukhus, Sjukhusvägen 10, 954 42, Södra Sunderbyn, Sweden
| | - C Odensten
- Department of Surgical and Preoperative Sciences, Surgery, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - D Darehed
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
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Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg 2022; 14:286-303. [PMID: 35664365 PMCID: PMC9131834 DOI: 10.4240/wjgs.v14.i4.286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.
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Affiliation(s)
- Anand Rajan
- Department ofGastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | | | - Jonathan Kessler
- Department ofInterventional Radiology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Trilokesh Dey Kidambi
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - James H Tabibian
- Department ofGastroenterology, UCLA-Olive View Medical Center, Sylmar, CA 91342, United States
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Partovi S, Li X, Moon E, Thompson D. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26:383-392. [PMID: 32063687 PMCID: PMC7002903 DOI: 10.3748/wjg.v26.i4.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube is an effective and safe long-term feeding access that is well-tolerated by patients. The typical placement routes include surgical, endoscopic and interventional radiologic placement. In particular, percutaneous interventional radiologic gastrostomy (PIRG) has increasingly become the preferred method of choice in many practices. Although many PIRG techniques have been developed since the 1980s, there is still a paucity of evidence supporting the choice of a most-optimal PIRG technique. Hence, there is a large variation in institutional approach to PIRG. We are a large, quaternary academic institution with an extensive experience in PIRG. Therefore, we aim to present the “push” PIRG technique utilized in our institution, to review the current literature, to discuss the optimal choice of PIRG technique and to generate further interests in comparison studies.
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Affiliation(s)
- Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Eunice Moon
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Dustin Thompson
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
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Ma S, Lamparello NA, Paik H, Nadolski G, Stavropoulos W, Tischfield D, Gade T, Shlansky-Goldberg RD. Single-Step Method for Pull-Type Gastrostomy Tube Placement. J Vasc Interv Radiol 2019; 31:473-477. [PMID: 31542269 DOI: 10.1016/j.jvir.2019.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
Single-step pull-type gastrostomy tube (PGT) placement is a method involving gastric puncture with a curved 18-gauge trocar needle allowing retrograde cannulation of the gastroesophageal junction without use of a sheath or snare. This retrospective review of 102 patients who underwent single-step PGT placement demonstrated 91% success in advancing the wire up the esophagus using only the curved trocar. Successful placement of a gastrostomy tube was 100%. Two major and 2 minor complications occurred within 30 days, all unrelated to the single-step technique. Mean fluoroscopy time for all patients was 5.1 min (range, 1.5-19.2 min). Single-step PGT placement is an effective, safe, fast, and equipment-sparing method for gastrostomy placement.
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Affiliation(s)
- Shawn Ma
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Nicole A Lamparello
- Interventional Radiology, Weill Cornell Imaging at New York-Presbyterian, New York, New York
| | - Helen Paik
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Gregory Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - David Tischfield
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Terence Gade
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Richard D Shlansky-Goldberg
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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