3:36 PM Abstract No. 222 Percutaneous radiologic gastrostomy with and without gastropexy: a prospective comparison

Enteral nutrition is the preferred method for providing supplemental nutrition in patients who cannot tolerate per oral intake; one route is percutaneous radiologic gastrostomy (PRG). Guidelines published by the Society of Interventional Radiology acknowledge insertion of PRG with or without gastropexy, but there is no official recommendation reflecting a lack of clear evidence. This study is aimed to prospectively compare pain levels and complications after PRG with gastropexy versus PRG without gastropexy. Research ethics board approved a dual arm, single-center, randomized, non-blinded trial of 60 patients undergoing primary PRG for dysphagia related to head and neck lesions, surgery, or radiation therapy. Patients were randomized to receive either PRG with gastropexy or without gastropexy. Data was collected for patient demographics, procedure duration, fluoroscopic time and complications (SIR adverse event classification). Patient symptom and quality of life data was collected in the form of questionnaires completed pre- and post procedure as well as 1-month after the PRG insertion. To date 40 patients have been recruited to the study (mean age, 60.4 years). 21 patients were randomized to the gastropexy group and 19 without gastropexy. One non-gastropexy patient was withdrawn from the study due to a technically challenging procedure which resulted in failed insertion and was not included in the analysis. PRG procedural time was significantly longer when involving gastropexy compared with non-gastropexy (MD = 4.94 mins, P <0.05). Fluoroscopy time did not differ between the two groups (NS). Pain scores did not differ between the two groups pre procedure, post procedure and 1-month follow-up (NS). There were 7/39 (17.9%) tube related complications (gastropexy = 2; non-gastropexy = 5), 3/39 (7.7%) minor complications (gastropexy = 3; non-gastropexy = 0) and 2/39 (5.1%) major complications (gastropexy = 0; non-gastropexy = 2). Major complications included abscess formation and a burst retention balloon resulting in intraperitoneal PRG position. Interim analysis shows that while procedure time is longer when gastropexy is used, there is a higher complication rate without gastropexy.