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Percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis (ALS) with minimal intravenous analgesia without gastropexy: evaluation of technical success, safety and efficacy
S182
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Wednesday
Scientific Session
predictors of poor clinical success. The rates of nonsevere and severe adverse-events were 27.5 and 2.5%, respectively, and 22.5% of patients underwent reinterventions. The median stent patency and survival were 33 (IQR, 19-60) and 35 days (IQR, 19-73), respectively. An ECOG score ≥ 3 was an independent predictor of a poor survival outcome (Hazard ratio, 4.681; P o 0.001). Conclusions: Overlapping SEMS placement may be safe and effective in patients with malignant gastroduodenal obstruction. References 1. Lopera JE, Brazzini A, Gonzales A, Castaneda-Zuniga WR. Gastroduodenal stent placement: current status. Radiographics: a review publication of the Radiological Society of North America, Inc 2004; 24:1561-1573. 2. No JH, Kim SW, Lim CH, et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointestinal endoscopy 2013; 78:55-62. 3. Maetani I, Isayama H, Mizumoto Y. Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study. Gastrointestinal endoscopy 2007; 66:355-360. 4. van Hooft JE, Uitdehaag MJ, Bruno MJ, et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointestinal endoscopy 2009; 69:1059-1066. 5. Tringali A, Didden P, Repici A, et al. Endoscopic treatm.
4:12 PM
Abstract No. 405
Percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis (ALS) with minimal intravenous analgesia without gastropexy: evaluation of technical success, safety and efficacy
WEDNESDAY: Scientific Sessions
N. Mani1, S. Kim2, A. Gunn3, R. Varma4; 1Mallinckrodt Institute of Radiology, Chesterfield, MO; 2Mallinckrodt Institute of Radiology Washington University in St Louis, St Louis, MO; 3Washington University in St Louis, St Louis, MO; 4Monroeville, PA. Purpose: Percutaneous radiologic gastrostomy has been the favored method for placing feeding tubes in patients in amyotrophic lateral sclerosis(ALS) and there is growing body of evidence that this may be the preferred technique over percutaneous endoscopic gastrostomy placement esepcially in patients with respiratory compromise. In these patients there is also some discussion and controversy in literature about how to manage the patients periprocedurally about the use of general anesthesia, conscious sedation or local anesthesia. Materials: In this retrospective study, we included 66 ALS patients(34 F: 32M, with age range of 31-89 years) who underwent percutaneous radiologic gastrostomy using retrograde approach using push technique over a period of 5 years. The procedures were done with flouroscopic guidance only.The electronic medical records, procedure charts and follow up clinical notes and imaging/interventional procedues were retrospectively analyzed for the type and amount of intravenous analgesics used, technical success, complications, reinterventions within a month. Results: The procedural success rate for percutaneous radiologic gastrostomy was 95.4% (63/66). Minimal intravenous sedation using opioid analgesic Fentanyl was used in
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JVIR
93.6% (58/63) of patients. Rest of the patients underwent the procedure with only local analgesia using 1% buffered lidocaine. The doses of Fentanyl ranged from 25mcg to 100mcg with a mean of 50mcg. The avearge hospital stay after the procedure was approximately 2.3 days. The procedure related complications (major and minor) were 6/63(9.5%) including site infection, pain, pneumoperitoneum and clogging. Reinterventions or management of complications were needed in the follow up period of 1 month in these patients. Conclusions: Percutaneous placement of gastrostomy is safe, effective procedure and can be performed with minimal intravenous analgesia using Fentanyl only in the ALS patients who can have severe respiratory compromise along with dysphagia from their bulbar involvement. General anesthesia was not needed in our subset of patients and this helps in reducing the need for additional resources for performing these procedures. References 1. J Neurol Neurosurg Psychiatry. 2004 Apr;75(4):645-7. 2. Arch Phys Med Rehabil. 2009 Jun;90(6):1026-9. 3. FJ Thornton, T Fotheringham, M Alexander. Radiology, 2002 Radiologic versus endoscopic placement of percutaneous gastrostomy in amyotrophic lateral sclerosis: multivariate analysis of tolerance, efficacy, and survival. Journal of Vascular Interventional Radiology, 2010 Enteral tube feeding for amyotrophic lateral sclerosis/motor neuron disease HD Katzberg, M Benatar. The Cochrane Library, 2011.
4:21 PM
Abstract No. 406
Retrospective review of safety and efficacy of percutaneous gastrostomy placement without gastropexy in extremely sick patients R. Johnson1, K. Vaheesan2, N. Gunji1, A. Kwong3, I. Moreno4, S. Gadani5; 1Saint Louis University Hospital, St Louis, MO; 2Saint Louis University Hospital, St Louis, MO; 3Saint Louis University School of Medicine, St Louis, MO; 4Saint Louis University, St Louis, MO; 5Ellisville, MO. Purpose: The purpose of our study was to evaluate the incidence of complications at initial placement of percutaneous gastrostomy or gastrojejunostomy (GJ) catheter without gastropexy in extremely sick patients. The recommended standard practice to improve the safety of percutaneous placement of gastrostomy catheters is with 2-3 gastropexy anchors. By our method, the gastric lumen is transgressed once without any gastropexy. Materials: The study was approved by our institution IRB. We performed a retrospective review of 176 patients. 3 cases were aborted because there was no safe percutaneous route. 2 cases had gastropexy, so were excluded. 4 cases were primary gastro-jejunostomy catheters (14 French Shetty Catheter -Cook). The remaining 167 cases had primary gastrostomy catheters between the dates of 1/1/2013 and 8/30/2015. 12 to 14 Fr Wills-Oglesby loop type (Cook) or 14-18 Fr Entuit balloon assisted Gastrostomy (Cook) were used. The chart was reviewed for all complications. Patient receiving anticoagulation and antiplatelet therapy were also included. Fluoroscopy time was recorded. Results: The patient ranged in age from 18-102 years, with a mean of 65 years. There were 50 females and 117 males. 102 cases (61%) patients received either antiplatelet or anticoagulant therapy at time of procedure. 86 cases had CVA, 57 cases had Head and Neck cancer, 6 had neuro-
’
Wednesday
Scientific Session
predictors of poor clinical success. The rates of nonsevere and severe adverse-events were 27.5 and 2.5%, respectively, and 22.5% of patients underwent reinterventions. The median stent patency and survival were 33 (IQR, 19-60) and 35 days (IQR, 19-73), respectively. An ECOG score ≥ 3 was an independent predictor of a poor survival outcome (Hazard ratio, 4.681; P o 0.001). Conclusions: Overlapping SEMS placement may be safe and effective in patients with malignant gastroduodenal obstruction. References 1. Lopera JE, Brazzini A, Gonzales A, Castaneda-Zuniga WR. Gastroduodenal stent placement: current status. Radiographics: a review publication of the Radiological Society of North America, Inc 2004; 24:1561-1573. 2. No JH, Kim SW, Lim CH, et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointestinal endoscopy 2013; 78:55-62. 3. Maetani I, Isayama H, Mizumoto Y. Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study. Gastrointestinal endoscopy 2007; 66:355-360. 4. van Hooft JE, Uitdehaag MJ, Bruno MJ, et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointestinal endoscopy 2009; 69:1059-1066. 5. Tringali A, Didden P, Repici A, et al. Endoscopic treatm.
4:12 PM
Abstract No. 405
Percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis (ALS) with minimal intravenous analgesia without gastropexy: evaluation of technical success, safety and efficacy
WEDNESDAY: Scientific Sessions
N. Mani1, S. Kim2, A. Gunn3, R. Varma4; 1Mallinckrodt Institute of Radiology, Chesterfield, MO; 2Mallinckrodt Institute of Radiology Washington University in St Louis, St Louis, MO; 3Washington University in St Louis, St Louis, MO; 4Monroeville, PA. Purpose: Percutaneous radiologic gastrostomy has been the favored method for placing feeding tubes in patients in amyotrophic lateral sclerosis(ALS) and there is growing body of evidence that this may be the preferred technique over percutaneous endoscopic gastrostomy placement esepcially in patients with respiratory compromise. In these patients there is also some discussion and controversy in literature about how to manage the patients periprocedurally about the use of general anesthesia, conscious sedation or local anesthesia. Materials: In this retrospective study, we included 66 ALS patients(34 F: 32M, with age range of 31-89 years) who underwent percutaneous radiologic gastrostomy using retrograde approach using push technique over a period of 5 years. The procedures were done with flouroscopic guidance only.The electronic medical records, procedure charts and follow up clinical notes and imaging/interventional procedues were retrospectively analyzed for the type and amount of intravenous analgesics used, technical success, complications, reinterventions within a month. Results: The procedural success rate for percutaneous radiologic gastrostomy was 95.4% (63/66). Minimal intravenous sedation using opioid analgesic Fentanyl was used in
’
JVIR
93.6% (58/63) of patients. Rest of the patients underwent the procedure with only local analgesia using 1% buffered lidocaine. The doses of Fentanyl ranged from 25mcg to 100mcg with a mean of 50mcg. The avearge hospital stay after the procedure was approximately 2.3 days. The procedure related complications (major and minor) were 6/63(9.5%) including site infection, pain, pneumoperitoneum and clogging. Reinterventions or management of complications were needed in the follow up period of 1 month in these patients. Conclusions: Percutaneous placement of gastrostomy is safe, effective procedure and can be performed with minimal intravenous analgesia using Fentanyl only in the ALS patients who can have severe respiratory compromise along with dysphagia from their bulbar involvement. General anesthesia was not needed in our subset of patients and this helps in reducing the need for additional resources for performing these procedures. References 1. J Neurol Neurosurg Psychiatry. 2004 Apr;75(4):645-7. 2. Arch Phys Med Rehabil. 2009 Jun;90(6):1026-9. 3. FJ Thornton, T Fotheringham, M Alexander. Radiology, 2002 Radiologic versus endoscopic placement of percutaneous gastrostomy in amyotrophic lateral sclerosis: multivariate analysis of tolerance, efficacy, and survival. Journal of Vascular Interventional Radiology, 2010 Enteral tube feeding for amyotrophic lateral sclerosis/motor neuron disease HD Katzberg, M Benatar. The Cochrane Library, 2011.
4:21 PM
Abstract No. 406
Retrospective review of safety and efficacy of percutaneous gastrostomy placement without gastropexy in extremely sick patients R. Johnson1, K. Vaheesan2, N. Gunji1, A. Kwong3, I. Moreno4, S. Gadani5; 1Saint Louis University Hospital, St Louis, MO; 2Saint Louis University Hospital, St Louis, MO; 3Saint Louis University School of Medicine, St Louis, MO; 4Saint Louis University, St Louis, MO; 5Ellisville, MO. Purpose: The purpose of our study was to evaluate the incidence of complications at initial placement of percutaneous gastrostomy or gastrojejunostomy (GJ) catheter without gastropexy in extremely sick patients. The recommended standard practice to improve the safety of percutaneous placement of gastrostomy catheters is with 2-3 gastropexy anchors. By our method, the gastric lumen is transgressed once without any gastropexy. Materials: The study was approved by our institution IRB. We performed a retrospective review of 176 patients. 3 cases were aborted because there was no safe percutaneous route. 2 cases had gastropexy, so were excluded. 4 cases were primary gastro-jejunostomy catheters (14 French Shetty Catheter -Cook). The remaining 167 cases had primary gastrostomy catheters between the dates of 1/1/2013 and 8/30/2015. 12 to 14 Fr Wills-Oglesby loop type (Cook) or 14-18 Fr Entuit balloon assisted Gastrostomy (Cook) were used. The chart was reviewed for all complications. Patient receiving anticoagulation and antiplatelet therapy were also included. Fluoroscopy time was recorded. Results: The patient ranged in age from 18-102 years, with a mean of 65 years. There were 50 females and 117 males. 102 cases (61%) patients received either antiplatelet or anticoagulant therapy at time of procedure. 86 cases had CVA, 57 cases had Head and Neck cancer, 6 had neuro-