CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2019; 03(01): 007-011
DOI: 10.1055/s-0039-1681124
Original Article
Indian Society of Vascular and Interventional Radiology

Pull-Type Radiologically Inserted Gastrostomy: An Improvised Technique Using a Frugal Innovation

Anurag Chahal
1   Department of Radiology, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
,
Sundeep Malla
1   Department of Radiology, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
,
Chinmaya Dash
2   Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
,
Deepak Gupta
2   Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
,
Shivanand Gamanagatti
1   Department of Radiology, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
› Author Affiliations
Further Information

Publication History

Received: 25 September 2018

Accepted: 16 October 2018

Publication Date:
27 March 2019 (online)

Abstract

Purpose To describe a new technique for “pull type” radiologically inserted gastrostomy (RIG) and prospectively compare it with conventional (described) technique in terms of technical ease (fluoroscopy time, radiation dose) and safety profile.

Materials and Methods Adult patients with head injury with Glasgow coma scale (GCS) (M score) < 5, one week after decompression or those requiring nutritional support for > 4 weeks, or patients with recurrent aspiration pneumonitis on nasogastric feeding were included. Hemodynamically unstable patients or those with uncorrectable coagulopathy were excluded. Patients underwent pull-type RIG with alternate patient getting allocated to groups A (conventional technique) and B (new technique). The authors compared the technical success, complication rate, fluoroscopy time, radiation dose, and cost of hardware in these two groups.

Results The average fluoroscopy time for group A (9 patients) was 498.7 ± 145.3 seconds, whereas for group B (16 patients), it was 302.8 ± 54.1 seconds with p-value = 0.06. The mean radiation dose of group A was 74.7 ± 15.7 mGy, whereas for group B, it was 56.7 ± 14.1 mGy (p-value = 0.004). The minor complication rates were 11.1% in both the groups.

Conclusion The authors’ innovative technique using a customized snare has the potential to increase the technical ease of pull-type RIG with reduced fluoroscopy time, radiation dose, and cost with a similar safety profile.

 
  • References

  • 1 Taylor SJ, Fettes SB, Jewkes C, Nelson RJ. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Crit Care Med 1999; 27 (11) 2525-2531
  • 2 Perel P, Yanagawa T, Bunn F, Roberts I, Wentz R, Pierro A. Nutritional support for head-injured patients. Cochrane Database Syst Rev 2006; (04) CD001530
  • 3 Kostadima E, Kaditis AG, Alexopoulos EI, Zakynthinos E, Sfyras D. Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients. Eur Respir J 2005; 26 (01) 106-111
  • 4 D'Amelio LF, Hammond JS, Spain DA, Sutyak JP. Tracheostomy and percutaneous endoscopic gastrostomy in the management of the head-injured trauma patient. Am Surg 1994; 60 (03) 180-185
  • 5 Thornton FJ, Fotheringham T, Haslam PJ, McGrath FP, Keeling F, Lee MJ. Percutaneous radiologic gastrostomy with and without T-fastener gastropexy: a randomized comparison study. Cardiovasc Intervent Radiol 2002; 25 (06) 467-471
  • 6 Szymski GX, Albazzaz AN, Funaki B. et al. Radiologically guided placement of pull-type gastrostomy tubes. Radiology 1997; 205 (03) 669-673
  • 7 Funaki B, Zaleski GX, Lorenz J. et al. Radiologic gastrostomy placement: pigtail- versus mushroom-retained catheters. AJR Am J Roentgenol 2000; 175 (02) 375-379
  • 8 Han K, Kim MD, Kwon JH. et al. Randomized controlled trial comparing radiologic pigtail-retained gastrostomy and radiologic mushroom-retained gastrostomy. J Vasc Interv Radiol 2017; 28 (12) 1702-1707
  • 9 Cantwell CP, Murray JG. Large-bore gastrostomy feeding tube insertion by a pull technique using a snare. Cardiovasc Intervent Radiol 2008; 31 (04) 811-813
  • 10 Narayanam S, Jaskolka J, Ho C. Percutaneous endoscopic gastrostomy (PEG) without endoscopy—a simplified technique of percutaneous trans-oral gastrostomy (PTOG). J Vasc Interv Radiol 2013; 24 (04) S154-S5
  • 11 Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D. Society of Interventional Radiology. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2009; 20 (07) Suppl S189-S191
  • 12 Kuo YC, Shlansky-Goldberg RD, Mondschein JI. et al. Large or small bore, push or pull: a comparison of three classes of percutaneous fluoroscopic gastrostomy catheters. J Vasc Interv Radiol 2008; 19 (04) 557-563 quiz 564