E5460. Comparison of Outcomes in Percutaneous Radiologic Gastrostomy Tube Placement by Tube Type and Size
  1. Saahil Chadha; Yale School of Medicine
  2. Diane Zhao; Yale School of Medicine
  3. Wilton Sun; Yale School of Medicine
  4. Connor Lewis; Yale School of Medicine
  5. Joshua Cornman-Homonoff; Yale School of Medicine
Gastrostomy tube placement is commonly performed in patients unable to maintain adequate caloric intake or for those with chronic bowel obstruction in need for decompression. Percutaneous radiologic gastrostomy tube placement offers several advantages over surgical placement; it can be performed under moderate sedation and often without the need for intubation, improving patient safety, facilitating scheduling, and decreasing costs. Despite the overall low risk of the procedure, procedural and postprocedural complications and the need for reintervention do occur. The purpose of this study is to compare by tube type and size, complication rates, and time course in adults with gastrostomy tubes placed under radiologic fluoroscopy.

Materials and Methods:
This single-center retrospective study included adults with attempted percutaneous gastrostomy tube placement under radiologic fluoroscopy during a 10-year study period (January 2012–December 2022). MIC and Pigtail tubes were placed via the push technique, and Ponsky tubes were placed via the pull technique. Patient charts were reviewed, and typical tube sizes ranged from 12–28 Fr. Postprocedural complications analyzed in this study include bleeding, dislodgement, leakage, malplacement, infection at the surgical site, as well as reintervention and 30-day survival. Multivariable logistic and linear regressions were conducted to control for covariates.

There were 2341 adult patients that met inclusion criteria for this study (mean age, 66 years; IQR, 58–75 years). Tube type was reported for 1858 patients, of which 769 were MIC, 103 were Pigtail, and 986 were Ponsky. Both tube type and size were reported for 1820 patients. Pigtail tubes were found to have significantly higher rates of reintervention than MIC tubes (OR 1.93; p = .002), as well as significantly earlier times to dislodgement (56 vs 167 days; p = .001), and to first reintervention (79 vs 147 days; p = .04). Among tubes placed via the push technique (MIC and Pigtail), larger tubes had significantly lower rates of complications and significantly later complications. Overall, larger MIC tubes were significantly more likely to dislodge later (p = .005) and have later time to first reintervention (p < .001). A head-to-head comparison of each MIC tube size confirmed these results. Larger Pigtail tubes were also found to be significantly less likely to dislodge than smaller tubes (OR 0.59; p = .03). Analysis of Ponsky tube outcomes yielded mixed results.

Among MIC and Pigtail tubes, dislodgement and reintervention rates and time courses varied significantly. MIC tubes were found to have better outcomes than Pigtail tubes. Across both types, larger tubes were found to have better outcomes than smaller tubes. This study has shown that not all types and sizes of gastrostomy tubes are equivalent. In the absence of contraindication, clinicians should prefer MIC and larger-sized tubes due to superior outcomes.