3:18 PM Abstract No. 220 A randomized controlled trial of metoclopramide versus placebo to reduce fluoroscopy time during gastrojejunostomy tube placement

Abstract

Gastrojejunostomy (GJ) tube placement is a common procedure performed to provide post pyloric nutritional support, but advancing a guidewire and the tube through the pylorus can be a tedious and time consuming step. The purpose of this study was to determine whether a single dose of the gastric promotility agent metoclopramide prior to GJ tube placement facilitates passage of the guidewire through the pylorus thus reducing fluoroscopy time. In this single-institution, randomized, double-blind, placebo-controlled trial, consecutive patients over 18 undergoing GJ tube placement were enrolled from April 9, 2018, to September 4, 2019. Patients unable to provide written consent or with metoclopramide allergy, altered pyloric anatomy (e.g., prior Whipple), long QT, extrapyramidal symptoms or seizure disorders were excluded. 51 patients were randomized to a single dose of metoclopramide 10 mg IV and 51 patients were randomized to placebo immediately prior to GJ tube placement. Balloon retained GJ tubes were placed using standard push technique. Fluoroscopy time, air kerma, and total procedure time were recorded. Groups were compared using t-tests and Fisher’s exact test. 43 of 51 patients (n = 33 males, mean age = 57) randomized to metoclopramide and 48 of 51 (n = 27 males, mean age = 54) randomized to placebo underwent GJ placement (P = 0.20). Mean fluoroscopy time to advance the guidewire from the stomach through the pylorus was 1.6 minutes (range, 0.3-10.1) in the metoclopramide group versus 4.2 minutes (range, 0.2-27.3) for placebo (P = 0.003). Mean total procedure fluoroscopy time was 5.8 minutes (range, 1.5-16.2) versus 8.7 minutes (range, 2.8-29.7) (P = 0.004). Mean air kerma was 90 mGy (range, 13-354) versus 124 mGy (range, 24-525) (P = 0.08). Mean total procedure time was 16.5 minutes (range, 8-51) versus 19.7 minutes (range, 6-53) (P = 0.07). There was no significant difference in the 30 day major complication rate (n = 1 in each group; P = 1.0). There were no drug related adverse events. A single dose of 10 mg metoclopramide immediately prior to GJ tube placement leads to a statistically significant reduction in fluoroscopy time by a factor of one third.