Radiologic versus Endoscopic Placement of Gastrostomy Tube: Comparison of Indications and Outcomes at a Tertiary Referral Center

Clayton, Steven; DeClue, Christopher; Lewis, Tracy R.; Rodriguez, Andrea C.; Kolkhorst, Kimberly; Syed, Rashid; Kumar, Amit; Davis, Clifford; Brady, Patrick

doi:10.14423/smj.0000000000000916

Cited by 14 publications

(4 citation statements)

References 13 publications

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“…Depending on the indications and center, investigators have reported higher mortality with IRG (4,5) or PEG (6) or no difference in mortality at all (7,8). The published data are typically limited to single-center studies with small sample sizes that are restricted to specific indications for gastrostomy (9)(10)(11). Indeed, a recent systematic review and meta-analysis assessing 15 prospective and retrospective studies was limited to 2,183 patients and only assessed the 30-day mortality (4).…”

Section: Introductionmentioning

confidence: 99%

Comparative Safety of Endoscopic vs Radiological Gastrostomy Tube Placement: Outcomes From a Large, Nationwide Veterans Affairs Database

et al. 2021

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INTRODUCTION: A gastrostomy is generally performed in patients who are unable to maintain volitional intake of food. We compared outcomes of percutaneous endoscopic gastrostomy (PEG) and interventional radiologist–guided gastrostomy (IRG) using an integrated nationwide database. METHODS: Using the VA Informatics and Computing Infrastructure database, patients who underwent PEG or IRG from 2011 through 2021 were selected using Current Procedural Terminology and International Classification of Diseases codes. The primary outcome was the comparative incidence of adverse events between PEG and IRG. Secondary outcomes included all-cause mortality. Comorbidities were identified using International Classification of Diseases codes, and adjusted odds ratio (OR) for adverse events were calculated using multivariate logistic regression analysis. RESULTS: A total of 23,566 (70.7 ± 10.2 years) patients underwent PEG and 9,715 (69.6 ± 9.7 years) underwent IRG. Selected frequent indications for PEG vs IRG were as follows: stroke, 6.8% vs 5.3%, P < 0.01; aspiration pneumonia, 10.9% vs 6.8%, P < 0.001; feeding difficulties, 9.8% vs 6.3%, P < 0.01; and upper aerodigestive tract malignancies 58.8% vs 79.8%, P < 0.01. Across all subtypes of malignancies of the head and neck and foregut, the proportion of patients undergoing IRG was greater than those undergoing PEG (P < 0.001). The all-cause 30-day mortality and overall incidence of adverse events were significantly lower for PEG compared with those for IRG (PEG vs IRG): all-cause 30-day mortality, 9.35% vs 10.3% (OR 0.80; 95% confidence interval [CI] 0.74–0.87; P < 0.01); perforation of the colon, 0.12% vs 0.24% (OR 0.50; 95% CI 0.29–0.86; P = 0.04); peritonitis, 1.9% vs 2.7% (OR 0.68; 95% CI 0.58–0.79; P < 0.01); and hemorrhage 1.6% vs 1% (OR 1.47; 95% CI 1.18–1.83; P < 0.01). DISCUSSION: In a large nationwide database of more than 33,000 gastrostomy procedures, PEG was associated with a lower incidence of adverse outcomes and the 30-day mortality than IRG.

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Section: Introductionmentioning

confidence: 99%

Comparative Safety of Endoscopic vs Radiological Gastrostomy Tube Placement: Outcomes From a Large, Nationwide Veterans Affairs Database

et al. 2021

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“…Additionally, endoscopically and radiologically guided gastrostomy tube placement has been associated with decreased overall morbidity and mortality. 19 20 Complication rates comparing endoscopically versus fluoroscopically placed gastrostomy tubes are not statistically significant; however, the types of procedural complications vary. 21 One limitation of endoscopically placed gastrostomy tubes is the need for a relatively large-caliber endoscope with reports documenting inadvertent tumor metastasis to gastrostomy placement sites, hypothesized to be secondary to seeding of more proximal head and neck tumors by the rigid endoscope.…”

Section: Prepyloricmentioning

confidence: 99%

Interventional Techniques to Support Enteral Nutrition

Long

Fernando

Boyd

et al. 2022

Digestive Disease Interventions

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“…If GBV are discovered, surgical team should be informed as it is pertinent information in planning and executing abdominal surgeries. By increasing awareness of this rare portosystemic shunt, we can prevent or decrease the incidence of massive bleeding from GBV, which in turn will decrease perioperative mortality [7][8][9][10][11].…”

Section: Case Reportmentioning

confidence: 99%

Not so innocent bystander - gallbladder varices without portal vein thrombosis

Milovanović

Dumić

Ilić³

et al. 2020

Srp Arh Celok Lek

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Introduction. Gallbladder varices (GBV) represent a rare form of ectopic varices that usually occur in patients with portal hypertension and portal vein thrombosis. Case outline. We present a case of a 38-year-old woman with decompensated autoimmune liver cirrhosis who was referred to our institution for evaluation for liver transplantation. She was incidentally discovered to have GBV during routine B-mode abdominal ultrasonography as part of pre-transplant evaluation. GBV were confirmed by Color Doppler Sonography (CDS), and multi detector computed tomography angiography. Interestingly, portal vein was patent and without thrombus. Conclusion. Despite being asymptomatic in most cases, the presence of GBV is valuable information for a surgeon because they might be a source of potentially catastrophic bleeding, which is particularly poorly tolerated by patients with decompensated liver cirrhosis. Ultrasound has the irreplaceable role not only in discovering GBV, but in prompt diagnosis of before mentioned rare, but unpredictable and fatal complications as well.

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Radiologic versus Endoscopic Placement of Gastrostomy Tube: Comparison of Indications and Outcomes at a Tertiary Referral Center

Cited by 14 publications

References 13 publications

Comparative Safety of Endoscopic vs Radiological Gastrostomy Tube Placement: Outcomes From a Large, Nationwide Veterans Affairs Database

Comparative Safety of Endoscopic vs Radiological Gastrostomy Tube Placement: Outcomes From a Large, Nationwide Veterans Affairs Database

Interventional Techniques to Support Enteral Nutrition

Not so innocent bystander - gallbladder varices without portal vein thrombosis

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