3:27 PM Abstract No. 221 Multicenter preliminary experience with percutaneous ultrasound gastrostomy: do interventional radiologists need fluoroscopy for gastrostomy placement?

To evaluate the initial feasibility and safety of percutaneous ultrasound gastrostomy (PUG) using the novel technique of magnetic gastropexy by interventional radiologists at two institutions. Institutional review board approval was obtained at both institutions, and all attempted PUG procedures were retrospectively reviewed. Data collected included BMI, procedural details, time to initiate feeds, and complications. Briefly, the stomach is coapted to the abdominal wall using an external high field magnet and orogastric tube with a ferromagnetic rod within an inflatable balloon. Direct ultrasound guidance is used to puncture the balloon and the balloon is used as a snare for a pigtail wire. A push technique self-dilating gastrostomy tube is then placed over the wire. Twenty patients underwent attempt at PUG. Patient demographics included a mean age of 67.3 ± 12 years and BMI of 24.0 ± 3.3 kg/m2. Most procedures were done with moderate sedation (17/20). Technically successful placement of PUG was achieved in 75% of patients (15/20), including one case performed completely at the bedside without fluoroscopy. Fluoroscopy was used for confirmation or assistance in placement during all other cases (median fluoro time, 1.5 ± 4.1 min). Three patients required adjunctive techniques for PUG placement. One patient with a gastroesophageal stricture required conversion to fluoroscopically guided gastrostomy tube placement. One major and one minor complication related to tube placement occurred. Additionally, one patient was admitted with aspiration pneumonia 16 days post procedure. Tube feeds were initiated in less than 24 hours in 16 patients. Percutaneous ultrasound gastrostomy (PUG) using a proprietary external magnet for coaptation gastropexy is a safe technique for gastrostomy placement, allowing prompt initiation of supplemental nutrition. This study demonstrates that as with all interventional radiology procedures, appropriate patient selection is critical. With continued experience and refinement of technique, fluoroscopy will not be required as was demonstrated with the successful bedside gastrostomy.