Abstract No. 211: Push vs. Pull Technique for Large-Bore Gastrostomy

Abstract

Peroral gastrostomies are associated with higher rates of aspiration, infection, and tumor seeding than percutaneously placed tubes. We evaluated a rapid, single-step antegrade large bore gastrostomy technique. Retrospective review of the IR procedure and medical records of contemporaneous cohorts of 83 patients that received primary large-bore gastrostomy placement was performed under IRB exemption. 39 patients received single-step antegrade 18-20F MIC balloon-tip gastrostomies placed via a pre-split 20F peel-away sheath, and 44 received peroral 20F Ponsky pull-type tubes. Procedure time, sedation requirements, primary technical success and intraprocedural complications were obtained from the perioperative records and the HI-IQ quality assurance database. Time-to-feed, time-to-goal, late complications, and need for tube replacement were obtained by retrospective review of the hospital records. Continuous procedural variables are reported as mean ± SD and compared with the t-test, and outcomes compared with the Fisher’s exact test. Primary procedural success was 100% for both types of tubes. Procedure time was 33 ± 24 min and 32 ± 13 min for push- and pull-types respectively, (P=0.8). Doses of fentanyl and midazolam were 101 ± 51 ug and 1.8 ± 1.1 mg for push- and 140 ± 73 ug and 2.5 ± 1.6 mg for pull-type tube placements, (P=0.01 and 0.009, respectively). There were 8 procedural complications with pull-type tubes (hypoxia/oversedation 4, site infection 3, aspiration 1) and 2 with push tubes (infection 1, aspiration 1) (p=0.09). Time-to-feed and time-to-goal were statistically similar (p=0.6); 4 patients with pull-type tubes never reached goal vs. 1 with a push type. 4 push-type tubes dislodged and required replacement vs. 1 pull-type. Single-step push-type large bore gastrostomies can be placed as rapidly as pull-types with significantly less sedation and a trend to fewer procedure-related complications.