Fluoroscopic-guided primary single-step percutaneous gastrostomy: initial results using the Freka® GastroTube]

Purpose: To determine the practicability and outcome of fluoroscopic-guided primary one-step treatment of percutaneous gastrostomy (PG) with the system Freka (R) Gastro Tube (Fresenius Kabi, Germany). Materials and Methods: In 39 patients (mean age 62.7 +/- 12.0 years), primary PG was performed based on clinical indication from August 2009 to April 2010. The intervention was performed by an experienced radiologist under aseptic conditions by direct puncture with Freka (R) Gastro Tube under fluoroscopic guidance. The clinical data and outcome as well as any complications originated from the electronic archive of the University Medical Center Hamburg-Eppendorf. Results: The intervention was technically successful in all 39 patients. Within the mean follow-up time of 155.3 +/- 73.6 days, 29 patients (74.4%) did not experience complications. 10 patients (25.6%) had to be revised. Complications manifested after a mean of 135.6 +/- 61.2 days and mainly corresponded to accidental dislocation (50%). One patient had to be surgically revised under suspicion of a malpositioned tube and suspected intestinal perforation. Clinically relevant wound infections were not detected. The total costs per patient were 553.17(sic) for our single-step treatment (OPS 5 - 431.x) vs. 963.69(sic) (OPS 5 - 431.x and OPS 8 - 123.0) for the recommended two-step treatment. Conclusion: Fluoroscopic-guided primary single-step treatment with Freka (R) Gastro Tube system is feasible and not associated with an increased complication rate when compared to published literature applying a two-step treatment approach. Material costs as well as human and time resources could be significantly reduced using the single-step treatment.