Abstract No. 497 Necessity of imaging follow up to confirm gastrostomy tube position prior to use

Abstract

To assess the value of obtaining routine next-day radiographic contrast tube study following placement of percutaneous push-type gastrostomy tubes From January 2015 to February 2020, all primary percutaneous push-type gastrostomy tube placement procedures have been identified. Demographic data, purpose of procedure (feeding versus venting), periprocedural (one month) complications, and results of next-day radiographic contrast tube studies (performed prior to initiation of tube feeding) were recorded. Retrospective review of procedural and next-day radiographic images of patients with abnormal tube studies was performed. A total of 267 procedures were identified. 261 patients received next-day radiographic contrast tube studies. 7 patients (2.6%) of those had abnormal studies with only 3 patients (1.2%) requiring surgical/interventional management. Tube studies revealed tube dislodgement in 3 patients, deflated balloon in one patient, false positive interpretation of extraluminal contrast in one study (ruled out by CT scan), and two cases of benign pneumoperitoneum. Retrospective review of the 3 patients with tube dislodgment revealed extraluminal tube placement evident on last archived fluoroscopic procedural images, not recognized during the procedure. 254 patients had normal post procedure tube study and of those; 3 cases were complicated by tube dislodgment (2 in day-2 and 1 in day-12 post procedure). Subsequent imaging for non–tube-related indications showed transhepatic tube placement in one patient and pneumoperitoneum in 12 patients (one with pneumatosis of the colon leading to negative surgical exploration). 6 patients did not receive next-day tube study; however, no periprocedural complications were encountered in this group. Routine use of radiographic contrast tube studies following primary placement of push-type gastrostomy tubes revealed tube mis-placement in few cases, all of which could have been detected intra-procedurally.