3:36 PMAbstract No. 401 - Is preprocedure barium necessary? Complication rate for percutaneous fluoroscopic-guided gastrostomy with and without barium

Abstract

To compare complication rates between percutaneous fluoroscopic-guided gastrostomy tube (PFG) placement with and without the presence of enteric barium. From September 2004 through July 2014, 539 patients at a public teaching hospital underwent PFG for nutrition. Images acquired during PFG placement were evaluated for presence of small or large bowel contrast. In all cases, the procedure was performed with maximal gastric air insufflation and multiple fluoroscopic projections to ensure absence of bowel interposition between the stomach and anterior abdominal wall. The medical records were evaluated for SIR-defined major and minor complications within 90 days of the procedure. Major complications included hemorrhage, necrotizing fasciitis, peritonitis, aspiration, tumor implantation, and death. Minor complications included ileus, peri-stomal infection, stomal leakage, buried bumper, gastric ulcer, and inadvertent removal of tube. Deaths occurring during the 90-day period were also evaluated separately. Of 539 patients, complete data were available on 515 (96%); 77 (15%) received barium and 438 (85%) did not. The overall 90-day major and minor complication rates were 4.3% and 10.7% respectively. The major complication risk difference was 0.4%; 3.9% with barium vs. 4.3% without (95% CI -4.3% to 5.2%). The minor complication risk difference was 4.9%; 6.5% with barium and 11.4% without (95% CI -1.3% to 11.2%). There were no bowel perforations in either group. One death (counted as a major complication) occurred in the no-barium group. There was minimal difference in the major complication rate of PFG with and without barium. There were no bowel perforations in either group. Our study suggests pre-procedure barium is not necessary to protect against inadvertent bowel injury during PFG.