New Approaches to Percutaneous Gastrostomy

Abstract

Novel approaches to percutaneous gastrostomy have evolved because of catheter clogging and displacement, which is commonly seen with currently available gastrostomy catheters. Low-profile button gastrostomy catheters, designed to be inserted into mature tracts, have recently been inserted into fresh gastrostomy tracts. Catheter clogging rarely occurs with these low-profile devices. Catheter displacement remains a problem but new buttons can be inserted at the patient's bedside without the need for a return visit to the radiology department. A 90 to 100% success rate has been shown for placement of gastrostomy buttons. Pull-type endoscopic gastrostomy catheters can be placed radiologically using a standard puncture of the stomach and cannulation of the gastroesophageal junction. A guide wire is manipulated up the esophagus and out the mouth. The pull-type gastrostomy catheter is then attached and pulled down through the esophagus and out through the anterior abdominal wall. These catheters have very good retention devices and rarely become dislodged. Catheter clogging is also rarely seen, provided larger devices are used. Radiological placement of percutaneous endoscopic gastrostomy tubes has been termed the ''hybrid method'' and has been shown to be cheaper than endoscopic and other fluoroscopic methods of gastrostomy.

One‐Step Insertion of Low‐Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy

“…In 2008, the MIC‐KEY Introducer Kit (Kimberly‐Clark Corporation, Roswell, GA) became available, which allows for initial placement of a low‐profile balloon G‐tube, thus bypassing the need for a second endoscopic procedure 6 . We perceived this as a benefit for use in our pediatric population given the risks associated with general anesthesia, as the MIC‐KEY Introducer Kit allows direct placement of the sustainable balloon‐retained G‐tube via an endoscopic video‐assisted procedure.…”

Primary placement of low-profile or ‘button’ versus traditional balloon-retention radiologically inserted gastrostomy catheters in adults: a retrospective review

“…Balloon retention catheters have largely supplanted Foley catheters and pigtail catheters as they are less predisposed to peritubal leakage and dislodgement. 4 7 11 Low profile balloon gastrostomy catheters, though initially intended for mature tracts, have been safely inserted de novo in the adult population. 4 8 LPG catheters are shorter in length and thus less prone to clogging.…”

“…Low-profile gastrostomy (LPG) or button-type gastrostomy catheters are shorter in tube length, providing a less obtrusive alternative to traditional pigtail or balloon retention catheters. 4 6 7 LPG placement was first described in patients with established gastrocutaneous tracts and is commonly performed in the paediatric population. 4 6 8 9 LPG catheters are typically placed in patients with an active lifestyle, those at risk for frequent gastrostomy dislodgement or in patients dissatisfied with the traditional catheter’s appearance.…”

“… 4 6 7 LPG placement was first described in patients with established gastrocutaneous tracts and is commonly performed in the paediatric population. 4 6 8 9 LPG catheters are typically placed in patients with an active lifestyle, those at risk for frequent gastrostomy dislodgement or in patients dissatisfied with the traditional catheter’s appearance. 4 8 9 A waiting time of approximately 3 months for tract maturation prior to exchange of a traditional gastrostomy catheter for an LPG has been suggested.…”

“… 4 8 9 A waiting time of approximately 3 months for tract maturation prior to exchange of a traditional gastrostomy catheter for an LPG has been suggested. 4 6 8 …”