04:12 PM Abstract No. 314 “Single-Step” Method for Pull-Type Gastrostomy Tube Placement

To evaluate the success, 30-day outcomes, complications and cost of the “single-step” method for pull-type gastrostomy placement (PGT) using a trocar needle shaped into an esophageal cannula (TNEC). An IRB-approved, retrospective review was performed of 102 patients (55 F, mean age 62.9) who underwent “single-step” PGTs by 3 operators between Oct 2012 - Aug 2018. The “single-step” PGT method involves a gastric puncture with an 18-gauge trocar needle, in which the distal 4cm of the needle has been gently curved 45° to perform retrograde cannulation of the gastroesophageal junction without the use of a sheath. The needle was curved with the internal stylet in place after being lubricated with Betadine petroleum ointment included in the 20 Fr. PGT kit (Halyard, Alpharetta, Georgia). Electronic inventory database, procedural reports and electronic medical records were evaluated for “single-step” success, fluoroscopy time, equipment cost and 30-day complications. Failure of “single-step” PGT was defined by the use of other equipment to cannulate the esophagus or retrieve the wire from the oropharynx including introducer sheaths, angiographic catheters, endoluminal forceps, or endovascular snares. The most common indications for PGT were cerebrovascular accident (35%; 36/102) and peritoneal carcinomatosis (18%, 18/102). 91.2% (93/102) of the procedures were successfully performed with the TNEC. There was no significant difference in success based on patient demographics or between different operators. Mean fluoroscopy time was 5.0 min for all-comers, 4.2 min for successes and 12.4 min for failures (p<0.001). The average inventory cost for “single-step” PGTs was $82.42, compared to $239.70 for balloon retention push-type tubes. Two major and 2 minor complications occurred within 30 days, all unrelated to TNEC technique. The major complications were tube malposition (transhepatic course) and aspiration during gastric insufflation. The “single-step” TNEC method is an effective, safe and fast option for placing PGTs. This technique simplifies and significantly reduces the cost of gastrostomy tube placement.