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Bendel EC, McKusick MA, Fleming CJ, Friese JL, A Woodrum D, Stockland AH, Misra S. Percutaneous radiologic gastrostomy catheter placement without gastropexy: a co-axial balloon technique and evaluation of safety and efficacy. Abdom Radiol (NY) 2016; 41:2227-2232. [PMID: 27344156 DOI: 10.1007/s00261-016-0808-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the short-term safety and efficacy of a co-axial angioplasty balloon technique for percutaneous radiologic gastrostomy catheter placement (PRG). METHODS A total of 65 percutaneous radiologic gastrostomy tube placements were performed with the co-axial angioplasty balloon technique from 10/1999 to 1/2014. This included 19 females and 46 males between the ages of 20-83. Without the use of T-fasteners for gastropexy, the gastrostomy tube was placed over a catheter-shaft angioplasty balloon as a co-axial system. The angioplasty balloon was used to sequentially approximate the stomach wall to the abdominal wall, dilate the tract, and was then used as a dilator to aid gastrostomy tube advancement into the gastric lumen. Technical success, complications, and dislodgements were evaluated by means of retrospective review of patient medical records and imaging. RESULTS There was no procedural failure in any of the 65 placements. 30-day follow-up was available for 56 patients. 7 patients died within 30 days; none of the deaths were recorded as procedure-related. There was 1 major complication (1.5%) consisting of a colocutaneous fistula. There were 4 minor complications (6.2%). There was no occurrence of bleeding or skin infection while using this technique. CONCLUSIONS PRG with the co-axial angioplasty-balloon technique is a safe and effective technique for gastrostomy placement.
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Affiliation(s)
- Emily C Bendel
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Michael A McKusick
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chad J Fleming
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jeremy L Friese
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David A Woodrum
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Andrew H Stockland
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sanjay Misra
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Vascular and Interventional Radiology Translational Laboratory, Mayo Clinic, Rochester, MN, USA
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Complications of Fluoroscopically Guided Percutaneous Gastrostomy With Large-bore Balloon-retained Catheter in Patients With Head and Neck Tumors. J Formos Med Assoc 2010; 109:603-8. [DOI: 10.1016/s0929-6646(10)60098-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 10/06/2009] [Accepted: 10/28/2009] [Indexed: 01/25/2023] Open
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Kuo YC, Shlansky-Goldberg RD, Mondschein JI, Stavropoulos SW, Patel AA, Solomon JA, Soulen MC, Kwak A, Itkin M, Chittams JL, Trerotola SO. Large or small bore, push or pull: a comparison of three classes of percutaneous fluoroscopic gastrostomy catheters. J Vasc Interv Radiol 2008; 19:557-63; quiz 564. [PMID: 18375301 DOI: 10.1016/j.jvir.2007.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 09/24/2007] [Accepted: 09/27/2007] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To compare the tube performance and complication rates of small-bore, large-bore push-type, and large-bore pull-type gastrostomy catheters. MATERIALS AND METHODS A total of 160 patients (74 men, 86 women; mean age, 66.9 years, range, 22-95 y) underwent percutaneous fluoroscopic gastrostomy placement between January 2004 and March 2006. Choice of catheter was based on the preference of the attending radiologist. Data were collected retrospectively with institutional review board approval. Radiology reports provided information on the catheter, indication for gastrostomy, technical success, and immediate outcome. Chart review provided data on medical history, postprocedural complications, progress to feeding goal, and clinical outcomes. Statistical analysis was performed to compare the three classes of gastrostomy catheters. RESULTS All 160 catheters were placed successfully. Patients who received small-bore catheters (14 F; n = 88) had significantly more tube complications (17% vs 5.6%) and were less likely to meet their feeding goal (P = .035) compared with patients with large-bore catheters (20 F; n = 72). No difference was observed in terms of major or minor complications. Large-bore push-type (n = 14) and pull-type catheters (n = 58) were similar in terms of complication rates. Patients who received large-bore push-type catheters achieved their feeding goals in significantly less time than those with large-bore pull-type catheters (average, 3.8 days vs 6.0 days; P = .04). CONCLUSIONS Patients who received small-bore gastrostomy catheters are significantly more prone to tube dysfunction. Large-bore catheters should be preferentially used, with push-type catheters performing better with regard to the time to achieve feeding goal.
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Affiliation(s)
- Yuo-Chen Kuo
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Shin KH, Shin JH, Song HY, Yang ZQ, Kim JH, Kim KR. Primary and conversion percutaneous gastrojejunostomy under fluoroscopic guidance: 10 years of experience. Clin Imaging 2008; 32:274-9. [DOI: 10.1016/j.clinimag.2007.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 10/20/2007] [Indexed: 11/26/2022]
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5
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Fluoroscopy-Guided Pull-Through Gastrostomy. Cardiovasc Intervent Radiol 2007; 31:142-8. [DOI: 10.1007/s00270-007-9179-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 07/16/2007] [Accepted: 07/29/2007] [Indexed: 01/25/2023]
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Given MF, Hanson JJ, Lee MJ. Interventional radiology techniques for provision of enteral feeding. Cardiovasc Intervent Radiol 2006; 28:692-703. [PMID: 16184329 DOI: 10.1007/s00270-004-7021-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Gastrostomy placement in patients who are unable to maintain their nutrition orally has been attempted using a variety of techniques over the past century. This includes surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy placement was the method of choice for almost a century, but has since been superseded by both endoscopic and radiological placement. There are a number of indications for gastrostomy placement in clinical practice today, with fewer contraindications due to the recent innovations in technique placement and gastrostomy catheter type. We describe the technique of gastrostomy placement, which we use in our institution, along with appropriate indications and contraindications. In addition, we will discuss the wide variety of catheter types available and their perceived advantages. There remains some debate with regard to gastropexy performance and the use of primary gastrojejunal catheters, which we will address. In addition, we will discuss the advantages and disadvantages of the three major types of gastrostomy placement currently available (i.e., surgical, endoscopic, and radiological) and their associated complications.
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Affiliation(s)
- M F Given
- Department of Academic Radiology, Beaumont Hospital, City, Ireland
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Lyon SM, Haslam PJ, Duke DM, McGrath FP, Lee MJ. De Novo Placement of Button Gastrostomy Catheters in an Adult Population: Experience in 53 Patients. J Vasc Interv Radiol 2003; 14:1283-9. [PMID: 14551275 DOI: 10.1097/01.rvi.0000092901.73329.eb] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the feasibility of primary button gastrostomy insertion with the aid of T-fastener gastropexy. MATERIALS AND METHODS Fifty-three consecutive patients (33 men, 20 women; mean age, 63.4 years) referred for percutaneous radiologic gastrostomy (PRG) underwent primary button gastrostomy insertion over an 18-month period in two centers. Nine of the patients (17%) were referred after failed endoscopic gastrostomy and 44 (83%) were primarily referred for PRG. Indications for gastrostomy included esophageal/head and neck malignancy (n = 33) and neurologic disorders (n = 20). Gastropexy with three or four T-fasteners was performed in all patients and angioplasty balloon catheters (6 mm x 40 mm) were used to measure tract length and dilate the tract. An 18-F dilator was used for final tract dilation. Button gastrostomy catheters with retention balloons were inserted in all patients. Patient follow-up was performed by the department of dietetics, which contacted patients on a weekly basis. RESULTS Primary button gastrostomy insertion was successful in 52 of 53 patients (98%). The mean gastrostomy button catheter survival was 13.3 weeks (range, 1-28 weeks). No episodes of button occlusion occurred. Since the beginning of this study, 33 patients (63%) have had their gastrostomy buttons replaced. The reasons for button replacement include burst retention balloons (n = 27; 52%), dislodgment of the catheter (n = 4; 8%), and continuing pain/discomfort at the gastrostomy site (n = 2; 4%). CONCLUSION Button-type gastrostomy catheters can be placed de novo by interventional radiologists without the need for a mature tract, provided a T-fastener gastropexy is used. The balloon retention button devices are not compromised by occlusion but do tend to become dislodged.
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Affiliation(s)
- Stuart M Lyon
- Radiology Department, Beaumont Hospital, Dublin 9, Ireland
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Abstract
Gastrostomy is a preferred method of nutrition in patients with impaired ability to eat. Although surgical gastrostomy is a well-established method and has been widely performed in the last century, beginning with early 1980s, percutaneous gastrostomy techniques, either endoscopic or radiologic, has widely gained acceptance. As percutaneous methods have been shown to be an effective, safe, easy to perform and low-cost techniques with low morbidity and mortality rates, nowadays percutaneous gastrostomy is the first method of choice in need of nutrition in patients with functioning gut. In this article authors review the technique of percutaneous radiologic gastrostomy, as well as indications, contraindications, variations of technique, ethical considerations, controversies and comparison with surgical and endoscopic methods.
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Affiliation(s)
- Mustafa N Ozmen
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.
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Funaki B, Peirce R, Lorenz J, Menocci PB, Rosenblum JD, Straus C, Ha TV, Leef JA, Zaleski GX. Comparison of balloon- and mushroom-retained large-bore gastrostomy catheters. AJR Am J Roentgenol 2001; 177:359-62. [PMID: 11461862 DOI: 10.2214/ajr.177.2.1770359] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We conducted a retrospective study to evaluate two different types of percutaneous fluoroscopic gastrostomy procedures and catheters. MATERIALS AND METHODS Between July 8, 1999, and August 4, 2000, 80 percutaneous gastrostomy catheters were placed in 80 patients in 80 attempts. Twenty-five 16-, 18-, or 20-French balloon-retained catheters and 55 20-French mushroom-retained catheters were inserted. Typically, the type of catheters placed was based on operator preference. However, balloon-retained tubes were preferred for use in patients with obstructive head and neck or esophageal malignancies, and mushroom-retained catheters were preferred for use in demented or combative patients. Follow-up was conducted through chart reviews and telephone interviews. The technical success, procedural complications, and catheter complications were recorded. Chi-square statistical analysis was performed. RESULTS Technical success was 100% (80/80 patients), and no procedural complications occurred. In patients who received balloon-retained catheters, the major complication rate was 0%, the minor complication rate was 8% (2/25 patients), and the tube complication rate was 68% (17/25 patients). The following complications occurred: catheter dislodgment (n = 17), superficial cellulitis (n = 1), and bleeding gastric ulcer (n = 1). In patients who received mushroom-retained catheters, the major complication rate was 0%, the minor complication rate was 3.6% (2/55 patients), and the tube complication rate was 3.6% (2/55 patients). The following complications occurred: superficial cellulitis (n = 2), tube occlusion (n = 1), and peristomal tube leakage (n = 1). No significant differences in major or minor complications were found between the gastrostomy procedures. Balloon-retained catheters had a significantly higher rate of tube complications (p < 0.001). CONCLUSION Compared with balloon-retained catheters, mushroom-retained gastrostomy catheters are significantly more durable, more secure, and less prone to tube dysfunction. Mushroom-retained catheters should be the preferred type of gastrostomy catheter to place in patients whenever possible.
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Affiliation(s)
- B Funaki
- Department of Radiology, MC 2026, The University of Chicago Hospitals, 5841 S. Maryland Ave., Chicago, IL 60637, USA
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Funaki B, Zaleski GX, Lorenz J, Menocci PB, Funaki AN, Rosenblum JD, Straus C, Leef JA. Radiologic gastrostomy placement: pigtail- versus mushroom-retained catheters. AJR Am J Roentgenol 2000; 175:375-9. [PMID: 10915678 DOI: 10.2214/ajr.175.2.1750375] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Two different types of percutaneous fluoroscopic gastrostomy procedures were prospectively evaluated. SUBJECTS AND METHODS Between January 1, 1998, and August 10, 1999, 127 percutaneous gastrostomy catheters were placed in 128 patients in 128 attempts. Seventy-five 12- or 14-French pigtail-retained catheters and fifty-two 20-French mushroom-retained catheters were inserted. Catheters were generally placed on the basis of operator preference except pigtail-retained tubes were preferentially placed in patients with head and neck or esophageal malignancies and mushroom-retained catheters were preferentially placed in neurologically compromised or combative patients. The technical success, procedural complications, and catheter complications were recorded. Statistical analysis was performed. RESULTS Ninety-nine percent (127/128) of the procedures were successful, and there were no procedural complications. One catheter was not placed because the colon intervened between the abdominal wall and stomach. In patients who received pigtail-retained catheters, the major complication rate was 3% (2/75), the minor complication rate was 8% (6/75), and the tube complication rate was 36% (27/75). The following complications were seen: tube occlusion (n = 12), inadvertent catheter removal (n = 8), peristomal tube leakage (n = 7), superficial cellulitis (n = 4), aspiration pneumonia (n = 2), and T-fastener cellulitis (n = 2). In patients who received mushroom-retained catheters, the major complication rate was 0%, the minor complication rate was 2% (1/52), and the tube complication rate was 2% (1/52). Complications were superficial cellulitis (n = 1) and partial catheter fracture (n = 1). There were no significant differences in major and minor complications between procedures. Pigtail-retained catheters had a significantly higher rate of tube complications (p < 0.001) CONCLUSION Compared with pigtail-retained catheters, mushroom-retained gastrostomy catheters are more durable and secure and are less prone to tube dysfunction. These catheters should be preferentially placed when possible.
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Affiliation(s)
- B Funaki
- Department of Radiology, The University of Chicago Hospitals, IL 60637, USA
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Giuliano AW, Yoon HC, Lomis NN, Miller FJ. Fluoroscopically guided percutaneous placement of large-bore gastrostomy and gastrojejunostomy tubes: review of 109 cases. J Vasc Interv Radiol 2000; 11:239-46. [PMID: 10716397 DOI: 10.1016/s1051-0443(07)61472-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To evaluate our experience with percutaneous placement, management, and complications of large-bore (20-24 F) gastrostomy and gastrojejunostomy feeding tubes. MATERIALS AND METHODS A retrospective review was performed on 109 consecutive patients who underwent placement of percutaneous large-bore feeding tubes between January 1994 and May 1998. Data were collected with respect to underlying illness, technical success, number of replaced tubes, and immediate and late complications. No patient had a small-bore tube placed during this series. RESULTS A total of 109 cases were reviewed. Immediate follow-up within the first 2 weeks was available for all 109. Follow-up after 2 weeks was available for 61 (56%) patients. Tubes were placed in patients aged 15 to 94 years. Neurologic dysfunction from a variety of causes was the most common underlying illness and occurred in 52% of patients. There were nine (8.3%) immediate, treatable complications: three major and six minor. There was one procedure-related death (0.9%). Persistent fistula tracts following tube removal occurred in three patients (4.9%). Balloon rupture was the most common reason for tube exchange (40.7%). CONCLUSION Percutaneous large-bore gastrostomy and gastrojejunostomy tubes are safe to place and have technical success, morbidity, and mortality rates comparable to those of tubes placed surgically or endoscopically as well as small-bore tubes placed with fluoroscopic guidance.
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Affiliation(s)
- A W Giuliano
- University of Utah School of Medicine, Department of Radiology and the Veterans Administration Medical Center, Salt Lake City, Utah, USA
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Funaki B, Zaleski GX. Single-step dilation for large-bore percutaneous gastrostomy and gastrojejunostomy. J Vasc Interv Radiol 1999; 10:234-5. [PMID: 10082111 DOI: 10.1016/s1051-0443(99)70468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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