4641. Bleeding Risk Associated with Percutaneous Transesophageal Gastrostomy Tube Placement
Authors * Denotes Presenting Author
  1. Karim Zaazoue *; Mayo Clinic - Jacksonville
  2. Jacob Core; Mayo Clinic - Jacksonville
  3. Zlatko Devcic; Mayo Clinic - Jacksonville
  4. Gregory Frey; Mayo Clinic - Jacksonville
  5. Ricardo Paz-Fumagalli; Mayo Clinic - Jacksonville
  6. Beau Toskich; Mayo Clinic - Jacksonville
  7. Charles Ritchie; Mayo Clinic - Jacksonville
Limited palliative options exist for patients with malignant bowel obstruction and contraindications to traditional percutaneous gastrostomy tubes (PG). This can occur in cases of primary or metastatic gastric malignancies, peritoneal carcinomatosis, no anatomic window for access, or in refractory ascites. A percutaneous transesophageal gastrostomy (PTEG) catheter is an alternative for these patients; however, data regarding PTEG procedural outcomes is limited within the literature, in particular, the incidents of bleeding. The purpose of this communication is to discuss the bleeding risks associated with the placement of PTEG in a single institutional experience and discuss the current available data.

Materials and Methods:
A retrospective review of all patients who underwent a PTEG catheter placement between December 2014 to January 2023 at two sites within one institution were identified. Data regarding reason for placement, outcomes, bleeding events, and anticoagulation usage were recorded for all patients.

A total of 74 patients underwent PTEG catheter placement, of which 56.3% were female and the median age was 58 years (range, 21 – 83). Seventeen patients were on uninterrupted anticoagulation, and four were on antiplatelet therapy during the PTEG procedure. One hemorrhagic event (1.4%) was reported (Grade I) in a patient not on anticoagulation or antiplatelet therapy and was treated conservatively without interventions.

PTEG catheter placement in this cohort was associated with a single hemorrhagic event (1.4%), and no hemorrhagic events were reported in the setting of uninterrupted anticoagulation or while on antiplatelet therapy. When compared with the available literature, this is less than the previous reported occurrences of 4%. Although this treatment modality is palliative in nature, it allows palliative patients to be discharged to hospice care without a nasogastric tube (NGT). The benefits of PTEG over NGT were evaluated in a randomized clinical trial by Aramaki et al; however, further investigations should be undertaken to compile more data for better classification of the bleeding risk of PTEG procedures.