Minimally invasive approaches to gastrostomy removal: the IR way

Learning Objectives • How to remove a gastrostomy - IR techniques. • What is the “Buried Bumper” syndrome? • How to remove a “stuck” gastrostomy - A pictorial illustration of different IR approaches to gastrostomy removal. • Complications associated with gastrostomy removal and how to avoid them. Background Percutaneous gastrostomy feeding tubes are required for an increasing number of patients with long-term nutritional requirements. Antegradely placed gastrostomy tube have internal retention discs (bumpers) that oppose the stomach wall to keep the tube in situ. Buried bumper syndrome (BBS) occurs in 2-6% of percutaneous gastrostomy placements making removal difficult. Traditionally these “stuck” tubes were removed by surgical or endoscopic methods. Interventional radiology techniques have developed that allow removal of buried bumpers without the recourse to surgery or the use of an endoscope. We explain these methods with pictorial illustrations describing how to perform them. Clinical Findings/Procedure Details Techniques for gastrostomy removal are described and illustrated including: • The cut and pass method and the inherent risks of this approach. • Push removal over a wire floss. • Balloon assisted removal with a pull technique. • Removal with pull technique using antegrade snare placement. Conclusion and/or Teaching Points Successful and safe gastrostomy removal is important to prevent complications varying from fistula formation and pain to duodenal perforation and ileal obstruction. Different approaches have been described many of which require endoscopic or surgical assistance. We describe methods that can be employed by IR to remove a gastrostomy that can even be successful in cases of buried bumper. This variety of techniques can allow gastrostomy removal without need for surgery or endoscopic assistance and avoids the complications of tube remnants remaining in the GI tract.