Percutaneous Gastrostomy Tube Research Articles

Prospective Evaluation of Absorbable Gastropexy Anchor Indwelling Time in 33 Patients

PurposeTo evaluate the time to absorbable suture gastropexy anchor release and gastropexy-related complications in patients receiving percutaneous image-guided transabdominal gastrostomy or gastrojejunostomy tube placement. Materials and MethodsThirty-three consecutive patients (16 women; mean age, 63.5 y; range, 25–92 y) undergoing fluoroscopically guided (n = 32) or computed tomography–guided (n = 1) percutaneous transabdominal gastrostomy (n = 26) or gastrojejunostomy (n = 7) were prospectively enrolled in a single-center study. Each patient had three synthetic absorbable suture T-fasteners inserted and were followed until all gastropexy button-locks released naturally, were cut by a health care provider, or were lost to follow-up. Patients or caregivers were contacted weekly to determine timing of gastropexy button-lock release and assess for postprocedural complications. ResultsAll three T-fastener button-type suture locks released naturally in 14 of 33 patients (42.4%) at a median of 29.5 days (mean, 26.7 d; range, 8–40 d). One or more T-fastener sutures were cut in 10 of 33 patients (30.3%), and nine patients (27.3%) were lost to follow-up. Accounting for patient censorship, T-fasteners in all 33 patients remained intact for a median of 35 days. Local infections developed in three patients (9%) on days 22, 25, and 34. ConclusionsRelative to nonabsorbable gastropexy sutures, absorbable suture gastropexy anchors offer the potential to reduce complications associated with long gastropexy indwelling times. However, absorbable gastropexy anchor buttons usually remain intact for longer than 3 weeks after insertion. A postprocedural plan for gastropexy inspection and removal within 3 weeks should continue to be emphasized to avoid local complications, even for absorbable suture kits.

Postpyloric decompression tube placement through a gastrostomy for malignant bowel obstruction

BackgroundMalignant bowel obstruction affect a patient’s quality of life, but, management of MBO is controversial.Case presentationA 51-year-old woman who had been diagnosed as uterine cervix cancer 2 years ago and had undergone surgery, chemotherapy and radiotherapy, was admitted to our hospital. She was diagnosed as having a recurrence of peritoneal metastasis and bowel obstruction. For her nasal pain, we considered insertion of a postpyloric decompression tube through the gastrostomy instead of via the nasal cavity. After insertion of a percutaneous gastrostomy tube was performed endoscopically, we introduced a postpyloric decompression tube through her gastrostomy. She could be discharged home, and 91 days later, she died in her home under hospice care, as she had wished.ConclusionsInsertion of a postpyloric decompression tube through a gastrostomy might be useful in the management of advanced cancer patients with bowel obstruction.

Experience over 12 years with home enteral nutrition in a healthcare area of Spain

The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study the outcome, as well as the clinical and epidemiological characteristics, of these patients. The present study aimed to analyse the incidence and characteristics of a cohort of patients on home enteral nutrition (HEN) over 12 years. A prospective observational study was performed between January 1999 and December 2010. All adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. The incidence of HEN ranged between 9.52 per 100, 000 inhabitants in 2001 to 30.0 per 100,000 inhabitants in 2009. HEN was administered orally in 472 patients (68.28%) (group 1), and through a nasogastric tube in 168 patients (24.30%), a percutaneous enteral gastrostomy tube in 47 patients (6.80%) and a jejunostomy in four patients (0.60%) (group 2; 219 patients). During the course of HEN, 31 patients had diarrhoea (4.5%), 17 patients had constipation and 12 patients had nausea. The mean (SD) duration of HEN was 159.9 (97) days. In multivariable analysis, an independent factor associated with death was age (hazard ratio = 1.03; 95% confidence interval - 1.01-1.05), adjusted by sex, route and diagnosis. HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.

Radiologic Percutaneous Gastrostomy: Review of Potential Complications and Approach to Managing the Unexpected Outcome

Radiologic percutaneous gastrostomy tube placement is a widely accepted method of enteral access for patients requiring long-term nutritional support for a variety of conditions. Although the safety of this procedure is well documented, complications do occur. The purpose of this article is to review the major and minor complications associated with gastrostomy tube placement and to present appropriate and effective management strategies. Familiarity with the potential complications, techniques for their prevention, and strategies for treatment will help practicing interventional radiologists successfully manage all possible outcomes.

Supraglottic Stenosis: Etiology and Treatment of a Rare Condition

Although laryngotracheal stenosis is well described in the literature, the vast majority of cases are of stenosis at either the subglottic or glottic level. Supraglottic stenosis is an unusual subset of laryngotracheal stenosis that has distinctly different causes, symptoms, and treatment options. A retrospective chart review was conducted on all adult patients at our institution with a diagnosis of supraglottic stenosis. Clinical records, videolaryngoscopic examinations, and operative and clinic procedure records were reviewed. All patients had a minimum follow-up of 12 months. Eight patients with supraglottic stenosis were identified. Five (62.5%) had a history of radiation therapy, and the remaining 3 cases were associated with autoimmune disorders. Our data revealed a frequent association with dysphagia (7 of 8 cases, or 87.5%), including 2 patients with complete pharyngoesophageal stricture and 3 who required a percutaneous gastrostomy tube. All of the patients required more than 1 surgical intervention because of symptomatic recurrent airway stenosis. Three patients underwent successful endoscopic treatment with a carbon dioxide laser in the operating room. One of these patients and 5 additional patients were successfully managed with pulsed KTP laser treatment in the clinic setting without complications. We observed 2 cases of acute intraoperative supraglottic edema in the setting of suspension laryngoscopy and jet ventilation, 1 of which necessitated emergent tracheostomy. Supraglottic stenosis is a rare condition that is often associated with external-beam radiation or autoimmune disorders. All of the patients in our series experienced some degree of symptomatic airway obstruction that required management. The majority also had coexisting dysphagia, often associated with pharyngeal or esophageal stricture. Despite the favorable response to endoscopic treatment, all patients eventually required additional procedures because of symptomatic recurrence of their stenosis. Although endoscopic surgical treatment with a carbon dioxide laser in the operating room setting is a viable option, office-based treatment with a pulsed KTP laser appears to be an effective and potentially safer alternative.

Pharmacokinetics of Levodopa, Carbidopa, and 3-O-Methyldopa Following 16-hour Jejunal Infusion of Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson’s Disease Patients

Motor complications of Parkinson's disease (PD) are a consequence of pulsatile dopaminergic stimulation from standard oral levodopa therapy. Levodopa-carbidopa intestinal gel (LCIG) is infused continuously via an intrajejunal percutaneous gastrostomy tube. This was the first study designed to characterize the full pharmacokinetic profiles of levodopa, carbidopa, and levodopa metabolite, 3-O-methyldopa (3-OMD) with 16-h LCIG infusion. Nineteen advanced PD patients (mean age, 65 years) who were on LCIG therapy for ≥30 days were enrolled. Patients received their individualized LCIG infusion doses, and serial pharmacokinetic samples were collected. Eighteen patients completed the study; 19 were assessed for safety. Mean (SD) total levodopa and carbidopa doses were 1,580 (403) and 395 (101) mg, respectively. Mean (SD) C(avg) (μg/mL) were 2.9 (0.84) for levodopa, 17.1 (4.99) for 3-OMD, and 0.22 (0.08) for carbidopa. The degree of fluctuation [defined as (C(max)-C(min))/C(avg)] in levodopa, 3-OMD, and carbidopa plasma concentrations was very low (0.52, 0.21, and 0.96, respectively) during hours 2-16 of infusion. Accordingly, the within-subject coefficients of variation in levodopa, 3-OMD, and carbidopa concentrations were low (13%, 6%, and 19%, respectively). Three patients (16%) reported ≥1 treatment-emergent adverse event; none were considered severe. Continuous intrajejunal LCIG infusion maintained stable plasma levodopa levels over 16 h. Consistent exposure has been shown to reduce motor and nonmotor complications associated with oral medications. LCIG was well tolerated, consistent with previous reports.

Percutaneous endoscopic gastrostomy placement: Caregiver decision making in Taiwan

To explore Taiwanese caregivers' decision making experiences of accepting a percutaneous endoscopic gastrostomy tube for their family member. A phenomenological approach was used for the interview and analysis. Semi-structured, in-depth interviews were conducted with a purposive sample of 26 caregivers of patients who had percutaneous endoscopic gastrostomy tube in southern Taiwan. Five themes were recognized to reflect caregivers' decision making experiences with a percutaneous endoscopic gastrostomy: awareness of suffering, awareness of options, uncertainty, opportunity, and contentment with the decision. Caregivers' decisions to proceed with a percutaneous endoscopic gastrostomy procedure were mediated by desires to relieve patients' suffering. To empower caregivers to make enteral feeding decisions, nurses must provide sufficient information about percutaneous gastrostomy tubes and their care, support decision making and help to identify an opportunity for gastrostomy tube placement.

Seeding of Head and Neck Cancer during Placement of Percutaneous Gastrostomy Tube

Seeding of Head and Neck Cancer during Placement of Percutaneous Gastrostomy Tube

Palliative Venting Gastrostomy in Patients with Malignant Bowel Obstruction and Ascites

Fluoroscopic-guided placement of a percutaneous decompression gastrostomy tube (PDGT) is used to palliate patients with malignant bowel obstruction (MBO). We report our clinical experience in cases of MBO and ascites that were known to be technically difficult and at increased risk for complications after PDGT placement. Between October 2005 and April 2010, a total of 89 consecutive oncology patients with MBO and ascites underwent at least one attempt at PDGT placement. We retrospectively reviewed the electronic medical record to collect demographic details, procedure information, and morbidity and mortality data. Kaplan-Meier curves were used to calculate median survival after PDGT. Ninety-three new gastrostomy encounters occurred in 89 patients. The primary and secondary technical success rates were 72 % (67 of 93) and 77.4 % (72 of 93), respectively. Inadequate gastric distention was the reason for failure in 84.6 % (22 of 26) of the cases in which the initial PDGT attempt was unsuccessful. For ascites management, 13 patients underwent paracentesis and 78 patients underwent placement of an intraperitoneal catheter. The overall complication rate in successful placements was 13.9 %, with a major complication rate of 9.7 %. After PDGT, the median overall survival rate was 28.5 days (95 % confidence interval 20-42). PDGT is feasible in the majority of patients with MBO and ascites, although there is an inherent risk of major complications. An intraperitoneal catheter can be used to manage ascites to facilitate PDGT.

Functional Outcomes of Chemoradiation in Patients with Head and Neck Cancer

Concurrent chemoradiotherapy (CCRT) has become the treatment of choice for oropharyngeal and hypopharyngolaryngeal cancers in many centers. Although it has increased the rates of organ preservation, there has also been an increase in treatment-related complications. We aimed to evaluate the functional outcomes of CCRT in head and neck cancer. Case series with chart review. Tertiary cancer center. A retrospective study of patients treated with CCRT at the University of Arkansas for Medical Sciences was performed. Demographic data and treatment outcomes were extracted, specifically feeding tube and tracheotomy dependence and number of esophageal dilatations. Of the 243 patients treated with concurrent chemoradiotherapy (5-fluorouracil + cysplatin and radiotherapy), 152 patients received a feeding tube. The median percutaneous gastrostomy tube (PEG) use was 9 months (range, 1-96 months). More than 70% of the patients who had a PEG more than 6 months had a T3 or T4 tumor. Thirty-seven patients underwent esophageal dilatations, (median, 1; range, 1-7). The median use of a tracheotomy was 7 months, and 77% of these patients were treated for hypopharyngolaryngeal cancer. Despite major improvement in locoregional control rates, CCRT has a significant negative impact on the functional outcomes of head and neck cancer patients, with a high number of patients remaining PEG and tracheotomy dependent.

Metastasis of untreated head and neck cancer to percutaneous gastrostomy tube exit sites

BackgroundPercutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive head and neck tumors. PEG tube placement is considered safe and complications are infrequent. MethodsA comprehensive review of the literature in MEDLINE (1962-2011) was performed. We report herein 3 new cases. ResultsThe literature search revealed 43 previous cases. The interval between PEG placement and diagnosis of metastasis ranged from 1 to 24 months. ConclusionsMetastatic cancer should be considered in patients with head and neck cancer that have persistent, unexplained skin changes at PEG site, anemia, or guaiac positive stools without a clear etiology. The direct implantation of tumor cells through instrumentation is the most likely explanation, although hematogenous and/or lymphatic seeding is also a possibility. Our review of the literature and clinical experience indicate that the “pull” technique of PEG placement may directly implant tumor cells at the gastrostomy site.

Su1306 Safety, Quality and Comfort of Upper Gastrointestinal Endoscopy With Conscious Sedation After Fasting for Two Hours

Su1306 Safety, Quality and Comfort of Upper Gastrointestinal Endoscopy With Conscious Sedation After Fasting for Two Hours

Su1307 Percutaneous Gastrostomy Tube Insertion by Gastroenterologists, Surgical Endoscopists, and Interventional Radiologists: Which Is Safer?

Percutaneous endoscopic gastrostomy tube insertion is a preferred ,less invasive method of gastrostomy tube placement. However,surgeons and interventional radiologists also routinely perform percutaneous gastrostomy tube(PGT)insertion.With escalating emphasis on quality control and reimbursement,a comparison of complications and outcomes in these three PGT placement groups is imperative.

VH31 Successful Closure of a Gastrocutaneous Fistula with an Over-the-Scope-Clip Device

A gastrostomy site usually spontaneously closes 2-3 days after removal of an endoscopically placed percutaneous gastrostomy (PEG) tube. Occasionally, a persistent gastrocutaneous fistula (GCF) can remain. Chronic nonhealing GCF remain patent and symptomatic greater than one month after PEG removal. Achieving successful closure of a GCF may require multimodal approach including the use of antisecretory and promotility agents, parenteral nutrition with NPO, silver nitrate cauterization, and standard endoscopic clipping. Literature suggests only limited success with above interventions. Refractory cases may necessitate surgical closure.

CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients

In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka® Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. Initial results suggest that the described technique under CT guidance is feasible and safe and may especially be advantageous in cases where endoscopic gastrostomy and sedation are contraindicated.

Percutaneous Gastrostomy Tube Placement Using a Balloon Catheter in Patients With Head and Neck Cancer

Patients with head and neck cancer frequently require gastrostomy feeding. The aim of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy with push-type gastrostomy tubes using a rupture-free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance in patients with head and neck cancer with swallowing disturbance or trismus. Percutaneous CT and fluoroscopic gastrostomy placement of push-type gastrostomy tubes using a RFB catheter was performed in consecutive patients with head and neck cancer between April 2007 and July 2010. The technical success, procedure duration, and major or minor complications were evaluated. Twenty-one patients (14 men, 7 women; age range, 55-78 years; mean age, 69.3 years) underwent gastrostomy tube placement. The tumor location was the pharynx (n = 8), oral cavity (n = 7), and gingiva (n = 6). Gastrostomy was performed in 15 patients during treatment and 6 patients after treatment. Percutaneous radiologic gastrostomy was technically successful in all patients. The median procedure time was 35 ± 19 (interquartile range) minutes (range, 25-75). The average follow-up time interval was 221 days (range, 10-920 days). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow-up periods. Percutaneous CT and fluoroscopic-guided gastrostomy with push-type tubes using a RFB catheter is a relatively safe and effective means of gastric feeding, with high success and low complication rates in patients with head and neck cancer in whom endoscopy was not feasible.

Does Percutaneous Gastrostomy Tubes Prevent Or Heal Decubitus Ulcers In Advanced Cognitive Impairment? (310-B)

1.Examine the existing evidence regarding the current use of PEG Feeding tubes in health outcomes of persons with advanced dementia.2.Recognize the implications of the current research study that finds that the use of PEG feeding tubes was not associated with prevention or improved healing of decubitus ulcers. Nearly ¾ of physician list decubitus ulcers (DU) as an indication for the use of feeding tube despite a 2009 Cochrane review finding inconclusive evidence to support this indication. Using national data, our goal was to examine whether percutaneous gastrostomy (PEG) tubes prevent or help heal DU in hospitalized nursing home residents (NH) with advanced cognitive impairment and recent onset of the need for eating assistance as indicated by new conversion from Cognitive Performance Score (CPS) to 6. A nearest neighbor propensity match control study was conducted by selecting 3 controls for each case (2,395 NH residents who had a feeding tube inserted during an hospitalization). Based on the Minimum Data Set, we examined two outcomes: (a) Whether a patient without a DU developed a Stage II and higher DU and (b) Whether NH residents with a DU stage II and higher DU had improvement of the DU by the next MDS assessment. Successful propensity matching is evident by a similar socio-demographic characteristic (eg, 28.9% black among those with PEG tubes compared to 29.7% among controls, similar rate of risk factors for feeding tube, and outcomes (ie, 58.1% vs. 58.9% 1-year mortality). Persons who got a PEG tube were 2.18 times more likely to develop a new DU (95% CI 1.9-2.5). Those with a DU were less likely to heal that ulcer when they had a PEG (OR 0.74; 95% CI 0.57-0.97). PEG FTs are not associated with prevention or improved healing of a DU. Rather, our findings suggests that PEG FTs harm NH residents with advanced cognitive impairment.

Fluoroscopy-guided percutaneous gastrostomy and nasogastric feeding tube placement: comparison of the clinical effect

Fluoroscopy-guided percutaneous gastrostomy and nasogastric feeding tube placement: comparison of the clinical effect

Percutaneous gastrostomy tubes in children with Pierre Robin sequence: efficacy, maintenance and complications

Children with Pierre Robin sequence (PRS) have significant oropharyngeal abnormalities, with respiratory and feeding difficulties. Gastrostomy tubes (G-tube) provide a means for nutrition. To evaluate the safety and efficacy of percutaneous G-tube insertion in children with PRS. Of 120 children with PRS (1996-2009), 40 were referred for G-tube insertion; clinical details were reviewed in 37/40 children (18M, 19F) at three time periods: (1) pre-G-tube insertion, (2) at G-tube insertion, (3) at G-tube removal. Pre-G-tube: 32/37 were term infants; 5 were preterm; 16/37 children were ≤ 10th weight percentile. At G-tube insertion, mean age was 66 days, mean weight 4.4 kg (1.1-7.0 kg); 19 dropped ≥10 weight percentiles; 12 tolerated nil by mouth; 2/37 were intubated for the procedure. All G-tubes were successfully placed, with five minor technical issues. Early postprocedure, there were eight minor complications and two dislodgements (classified as major). At G-tube removal mean G-tube dwell time was 2 years, with an average of 3.6 maintenance procedures per child, approximately 3 tube changes/1,000 tube days. At G-tube removal, 76% had maintained or increased weight centiles. G-tubes in PRS provide a safe method for nutrition until children feed adequately by mouth.

Acrodermatitis Enteropathica During Adequate Enteral Nutrition

Acrodermatitis enteropathica is a rare skin disorder of zinc deficiency. This case report describes a 91-year-old female nursing home resident who presented with a skin eruption resembling acrodermatitis enteropathica while receiving adequate enteral nutrition (EN) via a percutaneous gastrostomy tube. A low zinc level of 36 mcg/dL confirmed zinc deficiency, and treatment with oral zinc sulfate 220 mg 3 times a day resulted in rapid resolution of the skin lesions. This case supports the notion of close monitoring of patients on long-term EN for clinical manifestations of zinc deficiency, especially in the presence of an unexplained skin rash. Although micronutrient deficiencies are more prevalent in underdeveloped countries and with patients receiving parenteral nutrition, these deficiencies should be kept in mind for patients in developed countries as well as patients receiving EN.