H.4 Technically Challenging and High-Risk Gastrostomy Placement – Improving a Common Procedure
Gastrostomy catheters are placed by gastroenterologists, surgeons, and interventional radiologists. At Emory Midtown, for instance, we are one of the highest volume g-tube placement practices in interventional radiology (IR) given the high number of head and neck cancer patients. These feeding tubes become critical lifelines for patients when oral nutrition is not possible. Gastrostomy catheter placement remains a common procedure but with high risks – adverse events include life-threatening bleeding and infection (known as peritonitis). Placement is highest risk in patients with ascites (fluid in the abdomen) or where colon, liver, or lung may be found between the abdominal wall and the stomach. Thus, we may have a small but dangerous “window” whereby we can place the catheter. We often place 2-4 “t-fasteners” that help hold the stomach to the abdominal wall. These prevent the stomach from “slipping away,” which can lead to spillage of stomach contents into the abdomen and peritonitis or death. The challenge is that each t-tack requires an independent pass. In the patient with a small window or challenging approach, one pass may be all that we can achieve.
An ideal solution combines the benefits of the t-fasteners without requiring multiple passes. It would be functional in a multitude of patients for whom access can be difficult, whether in the setting of ascites or whereby colon or another organ is juxtaposed between the stomach and the small bowel.
- Biology/Pre-Health Experience