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Percutaneous fluoroscopic gastrostomy: is it better to “push” or “pull”?
JVIR
’
Scientific Session
Wednesday
only prophylactic CFZ prior to their PT type GT; (2) broad spectrum antibiotics prior to the procedure; (3) no periprocedural antibiotics. 3/32 patients receiving only prophylactic CFZ developed early gastrostomy site infections (9.4%). 2/49 patients receiving broad spectrum antibiotics developed early gastrostomy site infections (4.1%), and 1 additional patient developed peritonitis (2.0%). 3/45 patients that did not receive periprocedural antibiotics developed early gastrostomy site infections (6.7%). Conclusions: Our results show no statistically significant difference in the rate of early peristomal infections between patients who were treated with prophylactic CFZ, those treated with broad spectrum antibiotics, and those who received no periprocedural antibiotics (po0.05). Unexpectedly, patients receiving broad spectrum antibiotics demonstrated similar early infection rates compared to patients who did not receive any peri-procedural antibiotics. This finding may be due to these patients’ immunocompromised states or other chronic illnesses. Ultimately, our results confirm that use of prophylactic IV Cefazolin does not significantly reduce the rate of early post-procedural peristomal infections after PT type GT placement. References 1. Lynch CR, Fang JC. Prevention and Management of Percutaneous Endoscopic Gastrostomy Tubes. Practical Gastroenterology. 2010; 14(10):1-4. 2. Itkim M, et al. Multidisciplinary Practical Guidelines for Gastrointestinal Access for Enteral Nutrition and Decompression. August 2011: Vol 22 Number 8 (1089-1106). 3. Mandriata P, et al. Trends in percutaneous endoscopic gastrostomy placement in the elderly from 1993 to 2003. American journal of Alzheimer’s Disease and Other Dementia. 2012 Dec;27(8):609-13. 4. Cantwell CP, et al. Antibiotic prophylaxis for percutaneous radiologic gastrostomy and gastrojejunostomy insertion in outpatients with head and neck cancer. J Vasc Interv Radiol. 2008 Apr;19(4):571-5.
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tubes. The accompanying table lists reasons for reinterventions and complications. Conclusions: The “pull type” gastrostomy tubes have statistically significant lower rates of dislodgement and lower re-intervention rates compared to traditional “push type” gastrostomy tubes. When feasible, “pull type” gastrostomy tubes should be placed. Table 1
Total number Re-interventions Dislodged
“Push”
“Pull”
type group
type group
30
63
10 (33.3 %) 10
6 (9%) 3
Clogged
0
1
Pericatheter leakage Complications
0
2
Superficial abscess
0
2
Pericatheter leakage Small bowel obstruction
0 1
2 0
Peritoneal placement
1
0
4:03 PM
Abstract No. 404
Outcomes of overlapping self-expandable metallic stent placement in patients with malignant gastroduodenal obstruction
Purpose: To compare the “push type” and “pull type” gastrostomy tubes placed by Interventional Radiology. Materials: A retrospective medical chart review of gastrostomy tubes performed at IR department between January 2012 and January 2014 was conducted. Primary outcome measured was reintervation rate at 6 months. Major and minor complications were also recorded. Results: 93 gastrostomy tubes were placed in the study period. 63 were placed using the “pull type” method. 30 tubes were placed using the “push type” method. 6 out of 63 tubes(9%) in the “pull type” group required reintervation within 6 months. 10 out of 30 tubes (33%) in the “push type” group required reintervention within 6 months. The difference in the reintervation rate was statistically significant (z¼ 2.844, p ¼.01). All 10 reinterventions in the “push group” were due to tube dislodgement, 5 of which were due to deflated retention balloons. In the “pull group,” there were only 3 dislodged
Purpose: Self-expandable metallic stent (SEMS) placement is a well-established palliative treatment approach for malignant gastroduodenal obstruction. However, multiple stents placed in an overlapping fashion are often required in patients with a long stricture. The present study investigate the outcomes of overlapping SEMS placement in patients with malignant gastroduodenal obstruction. Materials: The medical records of 40 patients with malignant gastroduodenal obstruction who underwent overlapping SEMS placement at our institution were reviewed. Data on demographics, clinical characteristics, technical success, procedural details, clinical success, hospital stay, adverse-events, reinterventions, stent patency, and survival were collected. Results: The technical success rate was 100%. The mean length of the stricture was 17.0 ± 4.7 cm, and the mean number of stents placed in each patient was 2.2 ± 0.5. The clinical success rate was 65.0%. The median hospital stay was 12 days (interquartile range [IQR], 8-19). Metastatic cancer (Odds ratio [OR], 0.315; P ¼ 0.018), Eastern Cooperative Oncology Group (ECOG) score ≥ 3 (OR, 0.018; P ¼ 0.006), and carcinomatosis with ascites (OR, 0.025; P ¼ 0.017) were independent
3:54 PM
Abstract No. 403
A. Kumar1, A. Jon2, P. Shukla3, M. Kolber3, S. Contractor4; 1New York, NY; 2Rutgers-New Jersey Medical School, Newark, NJ; 3Mount Sinai Beth Israel, New York, NY; 4New Jersey Medical School, Newark, NJ
WEDNESDAY: Scientific Sessions
Percutaneous fluoroscopic gastrostomy: is it better to “push” or “pull”?
J. Tsauo1, G. Kim1, J. Kim1, Y. Cho1, J. Jun2, H. Song3, J. Park3; 1Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 2Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 3Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
’
Scientific Session
Wednesday
only prophylactic CFZ prior to their PT type GT; (2) broad spectrum antibiotics prior to the procedure; (3) no periprocedural antibiotics. 3/32 patients receiving only prophylactic CFZ developed early gastrostomy site infections (9.4%). 2/49 patients receiving broad spectrum antibiotics developed early gastrostomy site infections (4.1%), and 1 additional patient developed peritonitis (2.0%). 3/45 patients that did not receive periprocedural antibiotics developed early gastrostomy site infections (6.7%). Conclusions: Our results show no statistically significant difference in the rate of early peristomal infections between patients who were treated with prophylactic CFZ, those treated with broad spectrum antibiotics, and those who received no periprocedural antibiotics (po0.05). Unexpectedly, patients receiving broad spectrum antibiotics demonstrated similar early infection rates compared to patients who did not receive any peri-procedural antibiotics. This finding may be due to these patients’ immunocompromised states or other chronic illnesses. Ultimately, our results confirm that use of prophylactic IV Cefazolin does not significantly reduce the rate of early post-procedural peristomal infections after PT type GT placement. References 1. Lynch CR, Fang JC. Prevention and Management of Percutaneous Endoscopic Gastrostomy Tubes. Practical Gastroenterology. 2010; 14(10):1-4. 2. Itkim M, et al. Multidisciplinary Practical Guidelines for Gastrointestinal Access for Enteral Nutrition and Decompression. August 2011: Vol 22 Number 8 (1089-1106). 3. Mandriata P, et al. Trends in percutaneous endoscopic gastrostomy placement in the elderly from 1993 to 2003. American journal of Alzheimer’s Disease and Other Dementia. 2012 Dec;27(8):609-13. 4. Cantwell CP, et al. Antibiotic prophylaxis for percutaneous radiologic gastrostomy and gastrojejunostomy insertion in outpatients with head and neck cancer. J Vasc Interv Radiol. 2008 Apr;19(4):571-5.
’
S181
tubes. The accompanying table lists reasons for reinterventions and complications. Conclusions: The “pull type” gastrostomy tubes have statistically significant lower rates of dislodgement and lower re-intervention rates compared to traditional “push type” gastrostomy tubes. When feasible, “pull type” gastrostomy tubes should be placed. Table 1
Total number Re-interventions Dislodged
“Push”
“Pull”
type group
type group
30
63
10 (33.3 %) 10
6 (9%) 3
Clogged
0
1
Pericatheter leakage Complications
0
2
Superficial abscess
0
2
Pericatheter leakage Small bowel obstruction
0 1
2 0
Peritoneal placement
1
0
4:03 PM
Abstract No. 404
Outcomes of overlapping self-expandable metallic stent placement in patients with malignant gastroduodenal obstruction
Purpose: To compare the “push type” and “pull type” gastrostomy tubes placed by Interventional Radiology. Materials: A retrospective medical chart review of gastrostomy tubes performed at IR department between January 2012 and January 2014 was conducted. Primary outcome measured was reintervation rate at 6 months. Major and minor complications were also recorded. Results: 93 gastrostomy tubes were placed in the study period. 63 were placed using the “pull type” method. 30 tubes were placed using the “push type” method. 6 out of 63 tubes(9%) in the “pull type” group required reintervation within 6 months. 10 out of 30 tubes (33%) in the “push type” group required reintervention within 6 months. The difference in the reintervation rate was statistically significant (z¼ 2.844, p ¼.01). All 10 reinterventions in the “push group” were due to tube dislodgement, 5 of which were due to deflated retention balloons. In the “pull group,” there were only 3 dislodged
Purpose: Self-expandable metallic stent (SEMS) placement is a well-established palliative treatment approach for malignant gastroduodenal obstruction. However, multiple stents placed in an overlapping fashion are often required in patients with a long stricture. The present study investigate the outcomes of overlapping SEMS placement in patients with malignant gastroduodenal obstruction. Materials: The medical records of 40 patients with malignant gastroduodenal obstruction who underwent overlapping SEMS placement at our institution were reviewed. Data on demographics, clinical characteristics, technical success, procedural details, clinical success, hospital stay, adverse-events, reinterventions, stent patency, and survival were collected. Results: The technical success rate was 100%. The mean length of the stricture was 17.0 ± 4.7 cm, and the mean number of stents placed in each patient was 2.2 ± 0.5. The clinical success rate was 65.0%. The median hospital stay was 12 days (interquartile range [IQR], 8-19). Metastatic cancer (Odds ratio [OR], 0.315; P ¼ 0.018), Eastern Cooperative Oncology Group (ECOG) score ≥ 3 (OR, 0.018; P ¼ 0.006), and carcinomatosis with ascites (OR, 0.025; P ¼ 0.017) were independent
3:54 PM
Abstract No. 403
A. Kumar1, A. Jon2, P. Shukla3, M. Kolber3, S. Contractor4; 1New York, NY; 2Rutgers-New Jersey Medical School, Newark, NJ; 3Mount Sinai Beth Israel, New York, NY; 4New Jersey Medical School, Newark, NJ
WEDNESDAY: Scientific Sessions
Percutaneous fluoroscopic gastrostomy: is it better to “push” or “pull”?
J. Tsauo1, G. Kim1, J. Kim1, Y. Cho1, J. Jun2, H. Song3, J. Park3; 1Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 2Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 3Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea