Percutaneous Fluoroscopic Gastrostomy Research Articles

Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population

BackgroundIn the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles. Materials and MethodsA retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications. ResultsA total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22–1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28–2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24–1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78–2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03–2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33–1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01–1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72–1.87). ConclusionGastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications.

Randomized Controlled Trial Comparing Radiologic Pigtail-Retained Gastrostomy and Radiologic Mushroom-Retained Gastrostomy

PurposeTo prospectively compare 2 different types of percutaneous fluoroscopic gastrostomy procedures (pigtail-retained gastrostomy [PG] vs mushroom-retained gastrostomy [MG]). Materials and MethodsBetween March 2014 and February 2016, 100 patients were randomly assigned to receive 14-F PG or 20-F MG. Block randomization (block size 4) was performed, and sample size was calculated to assess the difference in minor complications. One patient withdrew from the study after allocation. Baseline characteristics were not significantly different between groups (P > .05). Technical success, defined as successful placement of gastrostomy tube, and procedural complications were evaluated. Procedural complications were divided into major and minor complications according to the Society of Interventional Radiology criteria. ResultsTechnical success rate was 100%. In the PG group, the major complication rate was 2% (1 of 50); 1 patient had a misplaced PG in the peritoneal cavity between the gastric and abdominal walls and developed peritonitis that had to be surgically treated. The minor complication rate was 34% (17 of 50) in the PG group. In the MG group, the major complication rate was 0%, and the minor complication rate was 12.2% (6 of 49). The most common minor complication was tube occlusion. Minor complication rate was significantly higher in the PG group (P = .016). Mean fluoroscopy time was significantly longer in the MG group (P = .013). ConclusionsBoth PG and MG demonstrated high technical success rates in all indications. MG had lower complication rates than PG at the cost of an increase in fluoroscopy times.

Profile of 151 Patients Undergoing Open Gastrostomy an a Cancer Hospital

The gastrostomy is a procedure that aims to ensure a feeding pathway for patients who are unable to maintain adequate long term oral intake. Currently there are described the classical open technique and minimally invasive techniques, such as percutaneous endoscopic and percutaneous fluoroscopic gastrostomy, each one with its profile of indications and complications.

3:54 PMAbstract No. 403 - Percutaneous fluoroscopic gastrostomy: is it better to “push” or “pull”?

3:54 PMAbstract No. 403 - Percutaneous fluoroscopic gastrostomy: is it better to “push” or “pull”?

Percutaneous Fluoroscopic Gastrostomy Catheter Placement: Is larger better than small bore?

Percutaneous Fluoroscopic Gastrostomy Catheter Placement: Is larger better than small bore? Abstract Aim: To compare the dysfunction and complication rates of small bore and large bore gastrostomy catheters. Material and Methods: A total of 521 patients (291 males, 230 females, mean age 56 years, range 16-90 years) underwent percutaneous fluoroscopic gastrostomy placement between August 2000 and January 2009. Choice of catheter was based on the preference of the Radiologist. Data was collected retrospectively without institutional review board approval requirement. Radiology reports provided clinical history, indication for gastrostomy, information of the catheter, technical success, and immediate outcome. Post procedural complications and clinical outcomes were obtained. Results: All catheters were placed successfully. 15 patients with anatomic difficulties for G tube placement were discarded from the study. Patients who received large bore and small bore catheters were compared. Patients with larger catheters (18F) had fewer short and long term complications and tube dysfunction compared to patients with smaller bore catheters (14F). Discussion and Conclusions: Patients who received small bore gastrostomy catheters were significantly more prone to tube dysfunction. Large bore catheters should be preferred for fewer complications in short and long term. Key Words: Fluoroscopy; Interventional; Percutaneous; Stomach; Catheters

Large or Small Bore, Push or Pull: A Comparison of Three Classes of Percutaneous Fluoroscopic Gastrostomy Catheters

To compare the tube performance and complication rates of small-bore, large-bore push-type, and large-bore pull-type gastrostomy catheters. A total of 160 patients (74 men, 86 women; mean age, 66.9 years, range, 22-95 y) underwent percutaneous fluoroscopic gastrostomy placement between January 2004 and March 2006. Choice of catheter was based on the preference of the attending radiologist. Data were collected retrospectively with institutional review board approval. Radiology reports provided information on the catheter, indication for gastrostomy, technical success, and immediate outcome. Chart review provided data on medical history, postprocedural complications, progress to feeding goal, and clinical outcomes. Statistical analysis was performed to compare the three classes of gastrostomy catheters. All 160 catheters were placed successfully. Patients who received small-bore catheters (14 F; n = 88) had significantly more tube complications (17% vs 5.6%) and were less likely to meet their feeding goal (P = .035) compared with patients with large-bore catheters (20 F; n = 72). No difference was observed in terms of major or minor complications. Large-bore push-type (n = 14) and pull-type catheters (n = 58) were similar in terms of complication rates. Patients who received large-bore push-type catheters achieved their feeding goals in significantly less time than those with large-bore pull-type catheters (average, 3.8 days vs 6.0 days; P = .04). Patients who received small-bore gastrostomy catheters are significantly more prone to tube dysfunction. Large-bore catheters should be preferentially used, with push-type catheters performing better with regard to the time to achieve feeding goal.

Percutaneous Gastrostomy and Gastrojejunostomy: Radiological and Endoscopic Approach

The aim of the study was to report our experience, comparing and evaluating the effectiveness, safety, indications, and obstacles of percutaneous placement of gastrostomy and gastrojejunostomy catheters by fluoroscopic (percutaneous fluoroscopic gastrostomy--PFG) and endoscopic (percutaneous endoscopic gastrostomy--PEG) techniques. In this retrospective comparative study over a five-year period, 52 patients were referred for gastrostomy or transgastric jejunostomy procedure for various reasons. Of these, 19 patients (36.5%) were referred for PEG and 33 patients (63.5%) were referred for PFG. The mean age was 65 years for PEG; 14 patients were male and 5 were female. The mean age for PFG was 51 years; 16 patients were male and 17 were female. The medical files and follow-up records of these patients were studied thoroughly. Success rate for catheter placement was high for both approaches (PFG and PEG), with a higher rate for PFG (100% vs. 89%). Major complications were 0% for PFG and 5.3% for PEG (P>0.05), whereas minor complications were 29% for PEG and 27% for PFG (P>0.05). Thirty-day procedure-related mortality was 0% for both techniques. Both PEG and PEG are successful, safe, and effective techniques for the installment of catheters in the stomach or jejunum. PEG technique appears to have no major complications, and is capable of overcoming some of the obstacles that may render PEG unsuccessful.

Percutaneous fluoroscopic guided gastrostomy: 6 Years experience in Jeddah, Saudi Arabia

Purpose: To assess the local experience with the percutaneous fluoroscopic gastrostomy (PG) with regard to indications, outcome, limitations and complications of the procedure. Method: Retrospective analysis of 33 patients in whom PG was requested and performed over a period of 6 years. Results: All 33 patients had successful catheter placement. Six patients had their catheters advanced to the jejunum (transgastric jejunostomy). Two patients had PG after failed endoscopic gastrostomy (EG). No major complications were encountered within the first 30 days. Minor complications were noted in seven patients (21%). Three patients (9%) had local infection at the stoma. The other four patients (12%) had catheter occlusion (use-related complications) that required catheter change. Longterm follow-up in eight patients showed a pericatheter leak at the stoma in three patients that was managed by change and step-up in the feeding catheter; French size. There was no 30-day mortality. Conclusion: The results indicate that PG is a safe and effective method for enteral feeding. It is useful for short and long-term feeding. Failed EG can be considered an indication for PG.

Systematic percutaneous fluoroscopic gastrostomy for concomitant radiochemotherapy of advanced head and neck cancer: optimization of therapy.

Wasting is a major complication of advanced head and neck cancer. Concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration represents a promising treatment modality for these tumors, but increases the risk of mucositis. This report describes the results achieved with percutaneous fluoroscopic gastrostomy (PFG) and its impact on the quality of life of patients with head and neck cancer in terms of their nutritional status. A total of 50 stage IV tumors of the oropharynx and hypopharynx recorded in a prospective database were reviewed retrospectively. All patients were managed by PFG, which was found to be a safe and effective technique with no technical failures. PFG feeding resulted in a mean increase in body weight of 2.5 kg within 3 weeks. The body mass index (BMI) was maintained at 3 and 6 weeks. Minor complications occurred, but no major complications were noted. The overall procedure-related mortality rate was nil. Further prospective investigations are necessary to determine whether treatment of wasting improves patient survival.

Percutaneous fluoroscopic gastrostomy tube placement in patients with head and neck cancer.

To study the safety and efficacy of percutaneous fluoroscopic gastrostomy tube placement in patients with head and neck cancer. We conducted a retrospective case review of 92 consecutive cases. Comparable access procedures and relevant literature were reviewed. Academic tertiary care center. Patients with head and neck cancer who underwent percutaneous fluoroscopic gastrostomy tube placement between January 1996 and July 1996. Immediate, delayed, and long-term complications; tube malfunction; and tube placement failure. The major complication rate was 1%; the minor complication rate was 8%; and the tube malfunction rate was 13%. The rate of successful tube placement was 98%. None of the patients required hospitalization as a result of the procedure. Percutaneous fluoroscopic gastrostomy tube placement is a safe, economical, and comfortable method that has distinct advantages over other gastrostomy tube placement methods. It is recommended for enteral feeding and nutritional supplementation in patients with head and neck cancer.

Percutaneous fluoroscopic gastrostomy

To assess the safety of percutaneous fluoroscopic gastrostomy (PFG) tube insertion for enteral nutrition. The records of 70 consecutive patients who had a PFG procedure at a tertiary referral hospital (Princess Alexandra Hospital) were analysed retrospectively. Incidence of morbidity and mortality from PFG. Sixty-nine of 70 procedures were successfully performed. There were two deaths secondary to aspiration pneumonia and a morbidity rate of 13%. These figures are comparable with results from other series. PFG is a safe, effective procedure for enteral nutrition.