Percutaneous Ultrasound Guided Gastrostomy Tube Placement: A Prospective Cohort Trial

Abstract

Background: To compare the safety and efficacy of percutaneous ultrasound guided gastrostomy (PUG) tube placement with traditional fluoroscopic guided percutaneous gastrostomy tube placement (PRG). Methods: A prospective, observational, non-randomized cohort trial was performed comparing 25 consecutive patients who underwent PUG placement between April 2020 and August 2020 with 25 consecutive patients who underwent PRG placement between February 2020 and March 2020. Procedure time, sedation, analgesia requirements, and complications were compared between the two groups in non-inferiority analysis. Results: Technical success rates were 96% in both groups (24/25) of procedures. Ninety-two percent of patients in the PUG cohort were admitted to the ICU at the time of G-tube request. Aside from significantly more COVID-19 patients in the PUG group ( P < .001), there was no other statistically significant difference in patient demographics. Intra-procedure pain medication requirements were the same for both groups, 50 micrograms of IV fentanyl ( P = 1.0). Intra-procedure sedation with IV midazolam was insignificantly higher in the PUG group 1.12 mg vs 0.8 mg ( P = .355). Procedure time trended toward statistical significance ( P = .076), with PRG being shorter than PUG (30.5 ± 14.1 minutes vs 39.7 ± 17.9 minutes). There were 2 non-device related major complications in the PUG group and 1 major and 1 minor complication in the PRG group. Conclusion: PUG is similar in terms of complications to PRG gastrostomy tube placement and a safe method for gastrostomy tube placement in the critically ill with the added benefits of bedside placement, elimination of radiation exposure, and expanded and improved access to care.

Percutaneous ultrasound gastrostomy (PUG) overview updates: response to an overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit

“…Most importantly, PUG is at least as safe as percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG). Two prospective studies (n=50) have shown an equivalent safety profile compared to matched retrospective cohorts (3,4). Critical care teams have demonstrated decreased time to gastrostomy placement for their patients when compared to PEG, decreased ICU length of stay (LOS) and immense utility in the COVID-19 pandemic (5)(6)(7).…”

“…Meeting this care demand requires a safe approach, ubiquitous to all critical care environments and critical care physicians. Point of care ultrasound is the optimal choice, as it has been safely utilized in both bedside tracheostomy and gastrostomy (3,4,6,7,9). When appropriately indicated, based upon current literature, PUG or TPUG can serve as a primary option for safe and timely care for your critically ill patients.…”

Response to the author on “Percutaneous Ultrasound Gastrostomy (PUG) overview updates” in response to our review on “An overview of percutaneous endoscopic gastrostomy (PEG) tube placement in the intensive care unit (ICU)’’

“…In the published studies of PUG, they had to use fluoroscopy as a bail out in significant number of patients. Furthermore, majority of the procedures were done in the interventional radiology (IR) suite and only a small number of patients underwent a true bedside gastrostomy in ICU (3)(4)(5)(6). Given the low number of PUG procedures performed in the ICU we cannot comment or extrapolate the conclusions on ICU-specific outcomes.…”

“…This disputes the whole purpose of the concept of combined tracheostomy Letter to the Editor Response to the author on "Percutaneous Ultrasound Gastrostomy (PUG) overview updates" in response to our review on "An overview of percutaneous endoscopic gastrostomy (PEG) tube placement in the intensive care unit (ICU)'' and gastrostomy in a single setting in ICU. In addition, PUG was performed by interventional radiologists with extensive expertise and experience in diagnostic ultrasound and percutaneous ultrasound-guided procedures (5,6). The study quoted by the authors on critical care physicians performing PUG is a very small study of five patients and cannot be used as a generalized measure without robust data and outcomes study with large patient population (7).…”

“…In support of their letter the author also quotes a more recent prospective, observational, non-randomized cohort trial by Reis et al looking at 25 patients who underwent PUG placement over a 5-month period between April 2020 to August 2020 with 25 consecutive patients who underwent Percutaneous Radiological Gastrostomy (PRG) placement over a 2-month period between February 2020 to March 2020 (5). In that study, 23 of 25 (92% of patients) were admitted to the ICU at the time of planned gastrostomy.…”