Simpler, Safer, and More Successful: A Focus on Morbidity and Mortality With Interventional Radiology Techniques Outperforming Surgery and Endoscopy for Enteric Tube Placement

Abstract

Introduction: Certain co-morbidities predispose patients to poor oral intake, thus creating a short and long-term requirement for nutritional support via enteric feeding tubes. Interventional radiology techniques have significantly improved as compared to traditional Gastroenterology procedures performed via surgical or endoscopic measures. Such advancements in tube placement have led to comparable success rates while concurrently decreasing morbidity and mortality. The following overview aims to discuss the current knowledge pertaining to the clinical application of enteral tube feeding with respect to indications, techniques, success rates, and complications by conducting a thorough literature review. Methods: An extensive literature review guided by the PubMed database was performed to retrospectively identify and study consecutive patients who underwent enteral tube placement via either surgical, endoscopic, or radiological methods. Success, complication, and 30-day mortality rates were then compared. Results: Gastrostomy feeding tubes had equivalent success rates but significantly higher complication rates and 30-Day mortality for surgical methods compared to radiological techniques [29.0% vs 13.3%; 2.5% vs 0.3%, respectively]. Results for jejunostomy feeding tubes were equivocal with the exception of endoscopic success rates being significantly lower than that of surgery or radiological intervention [68% vs 100% vs 92%, respectively]. Radiological techniques for gastrojejunostomy tube placement carried lower complication than surgery [4.2% vs 27.86%, respectively] but higher 30-Day Mortality rates [17.1% vs 6.56%]. Cecostomy results were equivocal and generally well tolerated by patients. Conclusion: Enteral tube feeding is often required in the hospital and outpatient setting to provide nutritional support for patients with certain neurological, mechanical, or post-operative indications. Traditionally, tube placement has been employed through surgical or endoscopic methods, resulting in increased cost of care and higher complication rates. More recently, the role of Interventional Radiology with regards to tube placement and management has been expanded due largely in part to the comparable success rates and decreased complication rates when compared with surgery or endoscopy.Table: Comparison of technical success rate, complication rate, and procedure related 30 day mortality rate with regards to endoscopic, surgical, and interventional enteral tube placement.Figure: AP Fluoroscopic image demonstrating dilated loops of jejunum with a 17-gauge needle overlying the puncture site (green arrow). Additionally, a nasojejunal tube is partially visualized (yellow arrow).Figure: AP Fluoroscopic image demonstrating contrast filled loops of jejunum with placement of 14 French gastrojejunostomy catheter (blue arrows).