A method for percutaneous radiologic gastrostomy tube placement without sedation as a bridge to lung transplantation

Abstract

Gastrostomy tube placement is an appropriate option for long-term nutritional support for patients who cannot tolerate oral intake. Common indications for a gastrostomy tube include head and neck tumors and neurological disorders. Several methods for gastrostomy tube insertion exist (eg, surgical, endoscopic, and radiologic) that require sedation or general anesthesia, which can pose risks of cardiopulmonary compromise and postsurgical pulmonary complications. Unlike other methods, our practice uses a percutaneous balloon-assisted gastrostomy tube insertion method for which we can perform without sedation. We report a case of a percutaneous radiologic gastrostomy procedure for a patient with end stage lung disease as a bridge to lung transplantation, who is not a candidate for sedation and is high-risk for general anesthesia. Through enteral feeds administered through the successfully placed gastrostomy tube, the patient showed steady improvement in weight gain over the course of several months before approval for listing by the lung transplant selection committee. Our case highlights how gastrostomy tube placement can be safely performed in patients who are not sedation candidates using the minimally invasive balloon-assisted gastrostomy tube insertion method and local anesthetic.

Balloon-assisted Jejunostomy Placement

“…e previous studies have also shown that percutaneous gastrostomy may be performed with only local anesthetic instead of moderate sedation, which has also proven true for balloon-assisted jejunostomy. [7] Avoiding general anesthesia and sedation may prevent comorbidityrelated complications including, but not limited to, cardiorespiratory and renal dysfunction. In addition, serial dilation has been noted to be a painful procedure for the patient, whereas balloon insertion appears to diminish the reported pain, reducing the need for analgesic use.…”