03:45 PM Abstract No. 48 Novel approach of transgastric balloon occlusion to increase technical success during pediatric percutaneous gastrostomy/gastrojejunostomy tube placement

Abstract

Obtaining adequate gastric distension via insufflation is a key step in creating a safe percutaneous window during gastrostomy/gastrojejunostomy (G/GJ) placement. In some instances, this may be limited due to rapid egress of air from the stomach into the duodenum, despite the use of glucagon. Herein, we describe an adjunctive novel technique of transgastric balloon occlusion to maximize gastric insufflation and assess the outcome of this technique use during G/GJ placement in children. A single-center, IRB-approved, retrospective review of 15 patients with a mean age 4.8±5.6 y (0-16y; 6F, 9M) and mean weight 20.9±18.9 kg (3-54.2 kg) who had G/GJ placement utilizing transgastric balloon occlusion over a 2-year period. The standard technique was antegrade placement with administration of glucagon. After initial percutaneous failure, the practice of positioning a balloon in the proximal duodenum was adopted to temporarily obstruct the gastric outlet. Clinical history, patient demographics, procedure reports, balloon type, technical success, and outcomes were reviewed. The addition of a transgastric balloon occlusion was successful in salvaging G/GJ tube placement in 10/15 (67%) patients (3G, 7GJ) which likely would have been unsuccessful using standard practice. Major underlying disorders included cardiac (n=5), neurologic (n=3), oncologic (n=2) and other (n=5). Of 5 unsuccessful placements, 3 were attributed to persistent colonic interposition/high position, 2 to high stomach position. Subsequently, 4 of 5 underwent surgical gastrostomy placement. No procedure-related complications were reported. The novel use of transgastric balloon occlusion may improve the technical success of G/GJ placement in children with challenging percutaneous access. Further studies are needed to assess the efficacy and identify optimal techniques and materials based on patient and disease characteristics.