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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024:10.1007/s00261-024-04381-x. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-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] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Chau LC, Soheim R, Dix M, Chung S, Obeid N, Hodari-Gupta A, Stanton C. Risk factors and natural history of bedside percutaneous endoscopic versus fluoroscopy-guided gastrostomy tubes in intensive care unit patients. Surg Endosc 2023; 37:8742-8747. [PMID: 37563346 DOI: 10.1007/s00464-023-10320-6] [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: 03/31/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION There is a paucity of literature comparing patients receiving bedside placed percutaneous endoscopic gastrostomy (PEG) versus fluoroscopic-guided percutaneous gastrostomy tubes (G-tube) in an intensive care unit (ICU) setting. This study aims to investigate and compare the natural history and complications associated with PEG versus fluoroscopic G-tube placement in ICU patients. METHODS All adult patients admitted in the ICU requiring feeding tube placement at our center from 1/1/2017 to 1/1/2022 with at least 12-month follow up were identified through retrospective chart review. Adjusting for patient comorbidities, hospital factors, and indications for enteral access, a 1-to-2 propensity score matched Cox proportional-hazards model was fitted to evaluate the treatment effect of bedside PEG tube placement versus G-tube placement on patient 1-year complication, readmission, and death rates. Major complications were defined as those requiring operative or procedural intervention. RESULTS This study included 740 patients, with 178 bedside PEG and 562 fluoroscopic G-tube placements. The overall rate of complication was 22.3% (13% PEG, 25.2% G-tube, P = 0.003). The major complication rate was 11.2% (8.5% PEG, 12.1% G-tube, P = 0.09). Most common complications were tube dysfunction (16.7% PEG; 39.4% G-tube; P = 0.04) and dislodgement (58.3% PEG; 40.8% G-tube). After propensity score matching, G-tube recipients had significantly increased risk for all-cause (HR 2.7, 95% CI 1.56-4.87, P < 0.001) and major complications (HR 2.11, 95% CI 1.05-4.23, P = 0.035). There were no significant differences in 1-year rates of readmission (HR 0.90, 95% CI 0.58-1.38, P = 0.62) or death (HR 1.00, 95% CI 0.70-1.44, P = 0.7). CONCLUSIONS The overall rate of complications for ICU patients requiring feeding tube in our cohort was 22.3%. ICU patients receiving fluoroscopic-guided percutaneous gastrostomy tube placement had significantly elevated risk of 1-year all-cause and major complications compared to those undergoing bedside PEG.
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Affiliation(s)
- Lucy Ching Chau
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
| | - Ryan Soheim
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Dix
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Sarah Chung
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Nadia Obeid
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | | | - Cletus Stanton
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
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Ahmed Z, Iqbal U, Aziz M, Arif SF, Badal J, Farooq U, Lee-Smith W, Gangwani MK, Kamal F, Kobeissy A, Mahmood A, Nawras A, Khara HS, Confer BD, Adler DG. Outcomes and Complications of Radiological Gastrostomy vs. Percutaneous Endoscopic Gastrostomy for Enteral Feeding: An Updated Systematic Review and Meta-Analysis. Gastroenterology Res 2023; 16:79-91. [PMID: 37187550 PMCID: PMC10181338 DOI: 10.14740/gr1593] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 05/17/2023] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are commonly utilized to establish access to enteral nutrition. However, data comparing the outcomes of PEG vs. PRG are conflicting. Therefore, we aimed to conduct an updated systemic review and meta-analysis comparing PRG and PEG outcomes. Methods Medline, Embase, and Cochrane library databases were searched until February 24, 2023. Primary outcomes included 30-day mortality, tube leakage, tube dislodgement, perforation, and peritonitis. Secondary outcomes included bleeding, infectious complications, and aspiration pneumonia. All analyses were conducted using Comprehensive Meta-Analysis Software. Results The initial search revealed 872 studies. Of these, 43 of these studies met our inclusion criteria and were included in the final meta-analysis. Of 471,208 total patients, 194,399 received PRG and 276,809 received PEG. PRG was associated with higher odds of 30-day mortality when compared to PEG (odds ratio (OR): 1.205, 95% confidence interval (CI): 1.015 - 1.430, I2 = 55%). In addition, tube leakage and tube dislodgement were higher in the PRG group than in PEG (OR: 2.231, 95% CI: 1.184 - 4.2 and OR: 2.602, 95% CI: 1.911 - 3.541, respectively). Perforation, peritonitis, bleeding, and infectious complications were higher with PRG than PEG. Conclusion PEG is associated with lower 30-day mortality, tube leakage, and tube dislodgement rates than PRG.
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Affiliation(s)
- Zohaib Ahmed
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
- Zohaib Ahmed and Umair Iqbal contributed equally and shared the first authorship
- Corresponding Author: Zohaib Ahmed, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.
| | - Umair Iqbal
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
- Zohaib Ahmed and Umair Iqbal contributed equally and shared the first authorship
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | | | - Joyce Badal
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Umer Farooq
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | | | - Faisal Kamal
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Abdallah Kobeissy
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Asif Mahmood
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Harshit S. Khara
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Bradley D. Confer
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO, USA
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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: 11] [Impact Index Per Article: 5.5] [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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Comparative Safety of Endoscopic vs Radiological Gastrostomy Tube Placement: Outcomes From a Large, Nationwide Veterans Affairs Database. Am J Gastroenterol 2021; 116:2367-2373. [PMID: 34506328 DOI: 10.14309/ajg.0000000000001504] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A gastrostomy is generally performed in patients who are unable to maintain volitional intake of food. We compared outcomes of percutaneous endoscopic gastrostomy (PEG) and interventional radiologist-guided gastrostomy (IRG) using an integrated nationwide database. METHODS Using the VA Informatics and Computing Infrastructure database, patients who underwent PEG or IRG from 2011 through 2021 were selected using Current Procedural Terminology and International Classification of Diseases codes. The primary outcome was the comparative incidence of adverse events between PEG and IRG. Secondary outcomes included all-cause mortality. Comorbidities were identified using International Classification of Diseases codes, and adjusted odds ratio (OR) for adverse events were calculated using multivariate logistic regression analysis. RESULTS A total of 23,566 (70.7 ± 10.2 years) patients underwent PEG and 9,715 (69.6 ± 9.7 years) underwent IRG. Selected frequent indications for PEG vs IRG were as follows: stroke, 6.8% vs 5.3%, P < 0.01; aspiration pneumonia, 10.9% vs 6.8%, P < 0.001; feeding difficulties, 9.8% vs 6.3%, P < 0.01; and upper aerodigestive tract malignancies 58.8% vs 79.8%, P < 0.01. Across all subtypes of malignancies of the head and neck and foregut, the proportion of patients undergoing IRG was greater than those undergoing PEG (P < 0.001). The all-cause 30-day mortality and overall incidence of adverse events were significantly lower for PEG compared with those for IRG (PEG vs IRG): all-cause 30-day mortality, 9.35% vs 10.3% (OR 0.80; 95% confidence interval [CI] 0.74-0.87; P < 0.01); perforation of the colon, 0.12% vs 0.24% (OR 0.50; 95% CI 0.29-0.86; P = 0.04); peritonitis, 1.9% vs 2.7% (OR 0.68; 95% CI 0.58-0.79; P < 0.01); and hemorrhage 1.6% vs 1% (OR 1.47; 95% CI 1.18-1.83; P < 0.01). DISCUSSION In a large nationwide database of more than 33,000 gastrostomy procedures, PEG was associated with a lower incidence of adverse outcomes and the 30-day mortality than IRG.
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Dolan RS, Duszak R, Bercu ZL, Martin JG, Newsome J, Kokabi N. Comparing the Safety and Cost of Image-Guided Percutaneous Gastrostomy Tube Placement in the Outpatient Versus Overnight Observation Setting in a Single-Center Retrospective Study. Acad Radiol 2021; 28:1081-1085. [PMID: 32527708 DOI: 10.1016/j.acra.2020.04.044] [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: 02/16/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES Historically, patients undergoing image-guided percutaneous gastrostomy tube placement have been admitted overnight with feeds commencing 12-24 hours postprocedure. With new expedited feeding protocols starting 3-4 hours postprocedure, same-day discharge is now possible. The purpose of this study was to evaluate the safety and cost of image-guided percutaneous gastrostomy tube placement as an outpatient procedure. MATERIALS AND METHODS In this retrospective study, 131 patients (age 63.9 ± 11.6; 34% female) underwent gastrostomy tube placement as an outpatient procedure with expedited feeding protocol versus 40 patients (age 61.3 ± 12.6; 38% female) who were hospitalized overnight with feeds starting at 12-24 hours, primarily based on operator preference. The two groups were compared regarding complications within 90 days of procedure. Using a subgroup of 33 consecutive patients, procedural costs (total combined insurer and patient payments for professional and hospital services) for outpatients vs. hospitalized patients were compared. RESULTS Complication rates were similar (p = 0.64) for gastrostomy tubes placed on outpatients (0.17 complications/procedure: 4 bleeding, 2 aspiration pneumonia, 1 abdominal abscess, 4 significant pain, 6 cellulitis, 1 surgical consult, 4 malpositioned/fractured tubes) and hospitalized patients (0.20 complications/procedure: 1 aspiration pneumonia, 1 significant pain, 3 cellulitis, 1 surgical consult, 2 fractured tubes). Total combined insurer and patient payments were similar ($2193/outpatient vs $2701/hospitalized patient; p= 0.52). CONCLUSION Outpatient image-guided percutaneous gastrostomy tube placement with an expedited feeding protocol is a safe and cost-comparable alternative to historic overnight hospitalization. Further prospective investigation with a larger sample is warranted.
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Maasarani S, Khalid SI, Creighton C, Manatis-Lornell AJ, Wiegmann AL, Terranella SL, Skertich NJ, DeCesare L, Chan EY. Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population. Surg Open Sci 2020; 3:2-7. [PMID: 33937737 PMCID: PMC8076911 DOI: 10.1016/j.sopen.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles. Materials and Methods A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications. Results A total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22–1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28–2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24–1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78–2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03–2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33–1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01–1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72–1.87). Conclusion Gastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications. Fluoroscopic g-tubes have higher odds of developing short- and long-term complications. Fluoroscopy has higher odds for abdominal wall pain and mechanical complications. Hyperlipidemia, smoking, and hypertension are risk factors for abdominal wall pain.
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Affiliation(s)
| | - Syed I Khalid
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | | | | | - Aaron L Wiegmann
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Samantha L Terranella
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Nicholas J Skertich
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Laura DeCesare
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Edie Y Chan
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
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Requarth JA. Image-Guided Palliative Interventions. Surg Clin North Am 2019; 99:921-939. [PMID: 31446918 DOI: 10.1016/j.suc.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews a few surgical palliative care procedures that can be performed by surgeons and interventional radiologists using image-guided techniques. Treatment of recurrent pleural effusions, gastrostomy feeding tube maintenance, percutaneous cholecystostomy, and transjugular intrahepatic portosystemic shunts (TIPS) with embolotherapy of bleeding stomal varices is discussed.
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Affiliation(s)
- Jay A Requarth
- 1959 North Peacehaven Road, #118, Winston Salem, NC 27106, USA.
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MDCT evaluation of complications of percutaneous gastrostomy tube placement. Emerg Radiol 2019; 26:663-674. [PMID: 31444681 DOI: 10.1007/s10140-019-01716-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/06/2019] [Indexed: 01/12/2023]
Abstract
Percutaneous gastrostomy tube placement is a commonly performed procedure to provide enteral alimentation to patients unable to tolerate oral feeds. Percutaneous gastrostomy is a relatively safe procedure, and serious complications like gastrointestinal bleeding, perforated viscus, and adjacent organ injury are rare. The most common complications after gastrostomy tube placement occur early and are usually minor. The purpose of this review article is to describe the techniques of percutaneous gastrostomy tube insertion and imaging protocol for gastrostomy tube evaluation, and describe the early, late, and anytime complications. The article will also illustrate very rare late complications of gastrostomy tube placement like gastro-hepatic fistula, gastro-colic fistula, buried bumper syndrome, and gastrostomy site hernia.
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