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At least 19 recordsLinked to original sources

PubMedDate not supplied

Comparison of Foley catheter as a replacement gastrostomy tube with commercial replacement gastrostomy tube: a prospective randomized trial.

Percutaneous endoscopic gastrostomy (PEG) provides a non-surgical alternative to long-term enteral feeding. The gastrostomy tube, however, may deteriorate, malfunction, or be accidentally expelled, requiring replacement. A commercial gastrostomy tube is commonly used for replacement. However, a commercial replacement gastrostomy tube is many times more expensive than a Foley catheter, and the two have never been compared. We compared the efficacy and safety of an all-silicone Foley catheter used as a replacement feeding gastrostomy tube with the effectiveness of a commercial replacement gastrostomy tube in 46 patients undergoing long-term enteral feedings per gastrostomy. Twenty-four patients were randomized to the Foley group and 22 patients to the commercial replacement gastrostomy tube group. The Foley catheter functioned well without need for replacement in 16 (66%) patients for 27.4 +/- 14.8 (mean +/- SD) weeks; the commercial replacement gastrostomy tube functioned in 13 (59%) patients for 24.5 +/- 13.6 weeks (p > 0.05, NS). The Foley catheter needed to be replaced because of malfunction in 8 (34%) patients and the commercial replacement gastrostomy tube in 9 (41%) patients after 21.6 +/- 11.5 weeks and 19.3 +/- 9.3 weeks, respectively (p > 0.05, NS). Neither the Foley catheter nor the commercial replacement gastrostomy tube migrated; this was the most striking finding, in contrast to case reports in the literature. Our data suggest that the Foley catheter can be safely used as a replacement gastrostomy tube; it is considerably cheaper than the commercial replacement gastrostomy tube, and its efficacy and complication rates are similar to those of the commercial replacement gastrostomy tube.

Catheters, Indwelling↗

PubMed1986

Comparison of percutaneous endoscopic gastrostomy with surgical gastrostomy at a community hospital.

The results of percutaneous endoscopic gastrostomies in 100 patients in a community hospital were compared with those of surgically placed gastrostomies in 50 patients. The morbidity rate for the percutaneous endoscopic gastrostomy group was 4%, compared with 30% for the patients with surgically placed gastrostomies. The procedure-related mortality for percutaneous endoscopic gastrostomy was 1%, compared with 16% for surgically placed gastrostomies. Patients admitted to the hospital for percutaneous endoscopic gastrostomy stayed an average of 4 days compared with 10 days for the surgical patients; 14 patients had the percutaneous endoscopic gastrostomy performed as an outpatient procedure. There were no complications in this group, suggesting that percutaneous endoscopic gastrostomy can be safely performed as an outpatient. In this community hospital, percutaneous endoscopic gastrostomy was both substantially safer and far less expensive than surgically placed gastrostomy.

Aged↗

PubMed2003

Complication rates and patency of radiologically guided mushroom gastrostomy, balloon gastrostomy, and gastrojejunostomy: a review of 250 procedures.

PURPOSE: To compare complication rates and tube performance of percutaneous mushroom gastrostomy, balloon gastrostomy, and gastrojejunostomy. METHODS: Between September 9, 1999 and April 23, 2001, 203 patients underwent 250 radiologically guided percutaneous gastrostomy and gastrojejunostomy procedures. Follow-up was conducted through chart reviews and review of our interventional radiology database. Procedural and catheter-related complications were recorded. Chi-square statistical analysis was performed. RESULTS: In patients receiving mushroom-retained gastrostomy catheters (n = 114), the major complication rate was 0.88% (n = 1), the minor complication rate was 5.3% (n = 6), and the tube complication rate was 4.4% (n = 5). In patients receiving balloon-retained gastrostomy tubes (n = 67), the major complication rate was 0, the minor complication rate was 4.5% (n = 3), and the tube complication rate was 34.3% (n = 23). In patients receiving gastrojejunostomy catheters (n = 69), the major complication rate was 1.4% (n = 1), the minor complication rate was 2.9% (n = 2), and the tube complication rate was 34.8% (n = 24). No statistically significant differences were found between procedural or peri-procedural complications among the different types of tubes. Mushroom-retained catheters had significantly fewer tube complications (p < 0.01). CONCLUSIONS: Percutaneous gastrostomy and gastrojejunostomy have similar procedural and peri-procedural complication rates. Mushroom gastrostomy catheters have fewer tube-related complications compared with balloon gastrostomy and gastrojejunostomy catheters. In addition, mushroom-retained catheters exhibit the best overall long-term tube patency and are therefore the gastrostomy catheter of choice.

Aged↗

PubMed2001

Do gastrostomies close spontaneously? A review of the fate of gastrostomies following successful renal transplantation in children.

Previous published data have shown the benefit of nutritional support delivered via a gastrostomy button (GB) for children on chronic dialysis. The use of the GB is suspended following renal transplantation (RT) in most children and it is usually removed 2-3 months later together with the chronic dialysis catheter when the child is on alternate-day steroids. We reviewed the outcome of gastrostomies following successful RT in children. The gastrostomies were created by an open technique (Stamm) with the child under general anaesthesia, usually at the time of insertion of a chronic dialysis catheter. Growth data and complications of the GB were collected in a prospective registry. Following RT, the GB was removed with the expectation that the tract would close spontaneously. Those in whom a gastrocutaneous fistula persisted underwent formal surgical closure. A total of 18 children have had gastrostomy buttons removed: 11 gastrostomies (61%) closed spontaneously, but 7 (39%) required operative closure at a median of 2 months (range 3 weeks-4 years) post-removal. The need for formal closure was significantly related to the duration that the gastrostomy had been in situ pre-transplant (non-parametric statistics, 0.05 > p > 0.01). Although nearly two-thirds of gastrostomies in this study closed spontaneously following RT, less than one-half of those that had been in situ for more than 1 year did so. We thus recommend formal closure of all gastrostomies that have been in situ for more than 1 year. This can be done at the same operation as the removal of the chronic dialysis catheter.

Adolescent↗

PubMedDate not supplied

Gastrostomy button placement through percutaneous gastrostomy tracts created with fluoroscopic guidance: experience in 27 children.

PURPOSE: The authors report their experience with skin level (button) gastrostomy placement through radiologically created gastrostomy tracts. PATIENTS AND METHODS: Fifty-two gastrostomy buttons have been placed in 27 children (average age, 73 months; range, 9-235 months). All buttons were placed through tracts created during earlier fluoroscopically guided percutaneous gastrostomy. Fifteen Bard mushroom-type buttons and 12 MIC-Key balloon-type buttons were initially placed. Patients have been followed up for an average of 13.4 months. RESULTS: Button placement was successful at the initial attempt in 25 of 27 patients (93%). Tract age at button placement averaged 18.5 weeks. The average tract length measured 3.5 cm (1.7-6.0 cm). Tract rupture and peritoneal leakage occurred in three patients; one patient had the button immediately repositioned without sequela, and the remaining two patients underwent replacement of the gastrostomy tube into the stomach and successful button placement approximately 1 week later. There were no major complications. Minor problems (leak, granulation tissue, valve malfunction, balloon breakage) occurred in 19 patients. CONCLUSION: Button gastrostomy is a useful alternative to the traditional gastrostomy tube for the pediatric population. Conversion with use of existing radiologically created tracts is possible and safe. Attention to tract integrity and proper button position is required to avoid complications.

Adolescent↗

PubMed2003

"Thoracic gastrostomy"--a new technique for feeding gastrostomy in wide-gap esophageal atresia and tracheo-esophageal fistula.

INTRODUCTION: Initial management of wide-gap esophageal atresia and tracheo-esophageal fistula, especially in developing countries, often involves ligation of the fistula, proximal esophagostomy and a gastrostomy. The conventional gastrostomy requires an abdominal incision and has several complications. The authors present an alternative technique of 'gastrostomy' that does not require an abdominal incision. METHOD: Through a standard right thoracotomy, the fistula is divided and tracheal end closed. If primary anastomosis is not possible due to wide gap, the lower esophageal pouch is mobilised and brought out as a stoma on the left posterior chest wall, lateral to the paraspinal muscles in the 7th or 8th intercostal space. A feeding tube is passed through the stoma into the stomach. The thorax is closed with a drain. Proximal esophagostomy is performed in the neck. The thoracic stoma is intermittently intubated for feeding until the child is ready for gastric transposition. RESULTS: The technique was successfully used in 5 patients. Feeding through the stoma could be established in 4. One patient had stomal retraction and died of resultant sepsis. One patient has subsequently undergone gastric transposition and one more is waiting for it. Two patients died of unrelated causes before esophageal replacement could be carried out. DISCUSSION: This is an alternative technique for feeding 'gastrostomy'. We have named the procedure as "Thoracic Gastrostomy" because the stoma is located on the chest but functions as a gastrostomy. The advantages include avoidance of a laparotomy and its complications, easy feeding by intermittent intubation, and availability of a virgin stomach for future gastric transposition.

Enteral Nutrition↗

PubMed1990

Combined endoscopic and surgical gastrostomy when percutaneous endoscopic gastrostomy is contraindicated.

The resurgence of enteral feeding, as both a more physiologic and cost-effective means of alimenting patients, has coincided with the increased popularity of endoscopically placed gastrostomies. Indeed, numerous retrospective studies have shown that percutaneous endoscopic gastrostomy (PEG) is superior to its surgical counterpart. There are, however, both absolute and relative contraindications to percutaneous placement. Reported here are three patients who were poor surgical candidates, yet had contraindications to percutaneous placement. Described is a method of combined endoscopic and surgical placement under local anesthesia used successfully in these patients. General anesthesia and laparotomy were not required. A 2-cm incision with endoscopic guidance was used and the gastrostomy was placed under direct vision and secured with a gastric purse string and sutured to the abdominal wall. There was no morbidity or mortality among the three cases reported. All gastrostomies were considered functional within 48 hrs. The authors feel this method is an excellent alternative when PEG is contraindicated. In addition, it may represent the safest and most effective method of gastrostomy placement in the majority of patients requiring a gastrostomy.

Adult↗

PubMedDate not supplied

Percutaneous gastrostomy in patients who fail or are unsuitable for endoscopic gastrostomy.

PURPOSE: Percutaneous endoscopic gastrostomy (PEG) is not possible or fails in some patients. We aimed to categorize the reasons for PEG failure, to study the success of percutaneous radiologic gastrostomy (PRG) in these patients, and to highlight the associated technical difficulties and complications. METHODS: Forty-two patients (28 men, 14 women; mean age 60 years, range 18-93 years) in whom PEG failed or was not possible, underwent PRG. PEG failure or unsuitability was due to upper gastrointestinal tract obstruction or other pathology precluding PEG in 15 of the 42 patients, suboptimal transillumination in 22 of 42 patients, and advanced cardiorespiratory decompensation precluding endoscopy in five of 42 patients. T-fastener gastropexy was used in all patients and 14-18 Fr catheters were inserted. RESULTS: PRG was successful in 41 of 42 patients (98%). CT guidance was required in four patients with altered upper gastrointestinal anatomy. PRG failed in one patient despite CT guidance. In the 16 patients with high subcostal stomachs who failed PEG because of inadequate transillumination, intercostal tube placement was required in three and cephalad angulation under the costal margin in six patients. Major complications included inadvertent placement of the tube in the peritoneal cavity. There was one case of hemorrhage at the gastrostomy site requiring transfusion and one case of superficial gastrostomy site infection requiring tube removal. Minor complications included superficial wound infection in six patients, successfully treated with routine wound toilette. CONCLUSION: We conclude that PRG is a safe, well-tolerated and successful method of gastrostomy and gastrojejunostomy insertion in the technically difficult group of patients who have undergone an unsuccessful PEG. In many such cases optimal clinical evaluation will suggest primary referral for PRG as the preferred option.

Adolescent↗

PubMed1994

A method for radiologic-assisted gastrostomy when percutaneous endoscopic gastrostomy is contraindicated.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) has been established as a faster and safer procedure than open surgical gastrostomy. It cannot be done, however, for many patients with partially obstructing pharyngeal or esophageal carcinoma, previous gastrectomy, upper abdominal surgery, or bowel distension from distal obstruction. PATIENTS AND METHODS: We attempted percutaneous radiologic-assisted gastrostomy (RAG) in 231 patients referred for gastrostomy, 38 of whom had a relative contraindication for PEG. The procedure involves passing, under radiologic guidance, an orogastric inflation tube that contains a snare. We used a 5-inch long, 18-gauge needle to transabdominally insert a wire into the stomach, avoiding loops of bowel visualized by air contrast. Retrieving the transabdominal wire by snare allowed retrograde passage of the gastrostomy tube as done in standard PEG. RESULTS: The procedure was successful in 230 of 231 cases, including 37 of the 38 patients with contraindications. We could not gain gastric access in 1 patient with a 75% gastrectomy. Overall, 6 patients developed complications and 1 died. There was no procedure-related morbidity or mortality in the patients with contraindications to PEG who underwent successful RAG. Subsequent laparotomy indicated tube passage through the liver in 2 of these cases and small bowel mesentery in 1 case without clinical problems. We performed a percutaneous jejunostomy in the efferent limb of the gastrojejunostomy in 1 patient with a previous gastrectomy. CONCLUSION: The snare technique is simpler and faster than the usual radiologic gastropexy technique, and safer than an endoscopic procedure. It has become our procedure of choice for gaining gastric access.

Adolescent↗

PubMed2001

The laparoscopic Janeway gastrostomy. An alternative technique when percutaneous endoscopic gastrostomy is impractical.

BACKGROUND AND STUDY AIMS: Today, percutaneous endoscopic gastrostomy (PEG) is the standard procedure for ensuring safe feeding access. In the case of advanced hypopharyngeal and esophageal carcinomas, it may not be feasible to pass an existing stenosis by endoscopy. The aim of this prospective study was to investigate the laparoscopic Janeway gastrostomy as an alternative technique for guaranteeing feeding access in these instances. PATIENTS AND METHODS: Between May 1993 and December 1999, 21 patients underwent laparoscopic Janeway gastrostomies. Indications were extended incurable tumors of the hypopharnyx (n = 12) and esophagus (n = 9) which rendered oral nutrition impossible and did not allow passage by the endoscope. RESULTS: The mean operative time was 38 minutes (range 24-50). No procedure-related intraoperative or postoperative complications were observed. All patients recovered quickly from surgery and the gastrostomies functioned well in all cases until the death of the patients. CONCLUSION: The laparoscopic Janeway gastrostomy is a safe and simple technique for palliative feeding access, avoiding a laparotomy in patients in whom percutaneous endoscopic placement is impractical.

Aged↗

PubMed1988

Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy.

In a review of 125 percutaneous endoscopic gastrostomies (PEG) and 88 Stamm gastrostomies performed at Duke University Medical Center since 1978, the average operating room time for PEG (50 +/- 20 min) was shorter than for Stamm (96 +/- 26 min) (p less than 0.0001). General anesthesia was administered in only 13% of PEG placements compared with 64% of Stamm gastrostomies. The cost of PEG was about $1000 less than for Stamm gastrostomies. The average time after surgery until use of the feeding tube was 1.8 days for PEG compared with 3.4 days for Stamm (p less than 0.0001). The overall complication rate after PEG was 8.8% (4.0% major) compared with 23.9% for Stamm gastrostomies (10.2% major) (p less than 0.005). PEG reduces operative time, necessity for general anesthesia, expense of insertion, incidence of complications, and requires less recovery time before use. PEG is the procedure of choice for gastric feeding access.

Anesthesia, General↗

PubMed1996

Laparoscopic gastrostomy versus open gastrostomy in head and neck cancer patients.

Alimentation in the surgically treated head and neck cancer patient frequently requires bypassing the upper aerodigestive tract. The laparoscopic gastrostomy fulfills this criterion. The authors compared 25 laparoscopic gastrostomies (group 1) with 18 open gastrostomies (group 2) performed on head and neck cancer patients. The length of operation, morbidity, mortality, and cost were evaluated. Operative time was significantly shorter in group 1 (40 +/- 2 minutes) than in group 2 (56 +/- 4 minutes), with P=.003. The major complication rate was 9% for group 1 and 11% for group 2. There was no procedure-related mortality in group 1, but 1 patient died in the immediate postoperative period in group 2. The cost was not significantly different. It is concluded that the laparoscopic gastrostomy is a safe and cost-effective alternative to open gastrostomy in this patient group.

Anesthesia, General↗

PubMed2002

Establishing radiological percutaneous gastrostomy with balloon-retained tubes as an alternative to endoscopic and surgical gastrostomy in patients with tumours of the head and neck or oesophagus.

The purpose of this study was to report our experience introducing radiological percutaneous gastrostomy (RPG) catheters at a hospital where hitherto only endoscopic and surgical methods have been used. The feasibility, success, time requirements, and complications of RPG were prospectively evaluated during a 12-month period. 26 consecutive patients (median age 63 years, range 41-91 years) underwent gastropexy with T-fasteners followed by insertion of a 12-18 F balloon tube through a peel-away introducer and were followed-up clinically and radiologically. Success and complications occurring within 30 days were assessed. RPG was technically successful in all cases. Median procedure time was 34 min (range 20-90 min), median fluoroscopy time 6.9 min (range 2.3-30 min). 13 surgical gastrostomies were avoided. One minor complication (peristomal leakage) occurred in a patient with gastric reflux and atony. Another patient destroyed the balloon of his tube by injecting food into the balloon port, which led to tube dislocation and peritonitis. In conclusion, radiological gastrostomy can be quickly learned by radiologists and is readily accepted by clinicians. It is an alternative to surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible, but can also be used as the primary method instead of the endoscopic method.

Adult↗

PubMed2006

Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) has increasingly replaced surgical gastrostomy (SG) as the primary procedure for the long-term nutrition of patients with swallowing disorders. This prospective randomized study compares PEG with SG in terms of effectiveness and safety. METHODS: This study enrolled 70 patients with swallowing disorders, mainly attributable to neurologic impairment. All the patients, eligible for both techniques, were randomized to PEG (pull method) or SG. The groups were comparable in terms of age, body mass index, and underlying diseases. Complications were reported 7 and 30 days after the operative procedure. RESULTS: The procedures were successfully completed for all the patients. The median operative time was 15 min for PEG and 35 min for SG (p < 0.001). The rate of complications was lower for PEG (42.9%) than for SG (74.3%; p < 0.01). The 30-day mortality rates were 5.7% for PEG and 14.3% for SG (nonsignificant difference). CONCLUSION: The findings show PEG to be an efficient method for gastrostomy tube placement with a lower complication rate than SG. In addition, PEG is faster to perform and requires fewer medical resources. The authors consider PEG to be the primary procedure for gastrostomy tube placement.

Adult↗

PubMed2006

Percutaneous radiologic gastrostomy using push-type gastrostomy tubes with CT and fluoroscopic guidance.

OBJECTIVE: The purpose of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy with endoscopic push-type gastrostomy tubes using CT and fluoroscopic guidance. CONCLUSION: Percutaneous radiologic gastrostomy using CT and fluoroscopic guidance with push-type tubes is a safe and effective means of gastric feeding that has few complications and offers an alternative to introducer-placed gastrostomy tubes.

Aged↗

PubMed2006

Laparoscopic-assisted percutaneous endoscopic gastrostomy: its role in providing enteric access when percutaneous endoscopic gastrostomy is not possible.

Percutaneous endoscopic gastrostomy (PEG) replaced open surgical gastrostomy (OSG) as the preferred method for enteric access soon after its introduction in 1980. Since that time, laparoscopic gastrostomy (LG), percutaneous radiologic gastrostomy (PRG), and laparoscopic-assisted PEG (LAPEG) have been introduced. PEG and PRG have been found to be over 95 per cent successful, convenient, economical, and associated with less morbidity than OSG. However, there are patients that are not appropriate candidates for, or have failed attempts at, PEG or PRG placement. At one time, OSG was the only option left for these patients, but they may be better served by LAPEG or, in some cases, LG. LAPEG offers less morbidity than OSG by having less pain and wound complications, and potentially may avoid the use of general anesthesia. We present a series of patients that underwent successful LAPEG placement after an unsuccessful attempt at PEG placement, and we describe its role in patient care.

Adult↗

PubMed1994

Laparoscopic gastrostomy versus percutaneous endoscopic gastrostomy. A comparison.

A retrospective study was carried out at our institution to compare patients who underwent percutaneous endoscopic gastrostomy (PEG) to those who underwent laparoscopic gastrostomy (LG). There were 17 patients who had a PEG with a mean age of 81 years (43-97 years). The procedure time, including complete esophago-gastroduodenoscopy, averaged 28 min. There were four deaths (23%) in a 30-day period, but none of these were directly related to the procedure. The LG group consisted of 14 patients with a mean age of 66 years (20-94 years). Mean duration of the procedure was 18 minutes. Thirty-day mortality rate was 35% (five patients) with one death (7%) directly related to the tube. Indications for gastrostomy were similar in both groups, being predominantly inability to eat and/or recurrent aspiration. However, LG was done because of 4 technical failures, 5 patients with tumors of the head and neck, 2 patients with esophageal obstruction and radiation stenosis precluding safe PEG, and 1 patient with hiatal hernia; 2 LGs were performed at the surgeon's preference. Outcomes for LG and PEG were comparable. LG is a suitable, safe alternative to PEG in selected patients who cannot undergo gastroscopy and should be considered the procedure of choice in patients with head and neck tumors or intrathoracic pathology that prevents PEG.

Adult↗

PubMed2002

[Primary operative gastrostomy or percutaneous endoscopic gastrostomy (PEG) in progressive oesophageal carcinomas? A case report on abdominal wall metastases following PEG].

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a safe and easy procedure used to provide enteric nourishment in patients with non-operable, constricting, malignant tumors of the oropharynx or esophagus. However, as a late complication, the development of abdominal wall metastases have been described, the mechanism of which is controversially. PATIENTS AND METHODS: We describe two cases in which abdominal wall metastases developed 9 and 14 months, respectively, following PEG. Both patients suffered from an advanced esophageal carcinoma. One patient had to undergo surgery because of the size of the metastasis. This was followed by several weeks of hospital treatment. The second patient was already in a prefinal condition so that no surgical procedure was performed. Reviewing the current literature, we discuss the question of whether, in certain cases, an operative gastrostomy should be preferred to a PEG. RESULTS: As in our opinion the reason for abdominal wall metastases is direct tumor seeding, we suggest that in certain cases, in order to avoid a possible metastasis resection, an operative gastrostomy should be discussed. This is particularly relevant if the tumor is constricting with a high risk of losing tumor cells. If possible, a minimal-invasive method is to be preferred.

Abdominal Neoplasms↗