Zener Rebecca, Istl Alexandra C, Wanis Kerollos N, Hocking David, Kachura Jacob, Alshehri Shaker, Mujoomdar Amol, Latosinsky Steven, Wiseman Daniele
London Health Sciences Centre, Victoria Hospital, Western University, Department of Medical Imaging, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada.
London Health Sciences Centre, Victoria Hospital, Western University, Department of General Surgery, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada.
Clin Imaging. 2018 Jul-Aug;50:104-108. doi: 10.1016/j.clinimag.2018.01.001. Epub 2018 Jan 10.
Our objective was to assess 30-day mortality and complication rates associated with percutaneous enteral feeding tube insertion using a single-puncture, dual-suture anchor gastropexy and peel-away sheath technique. We explored differences in complications based on indication and gastrostomy versus gastrojejunostomy tube.
A retrospective review was conducted of adult patients undergoing fluoroscopically guided gastrojejunostomy (GJ) and gastrostomy (G) tube insertions between July 2011 and 2014 by five interventional radiologists at a single tertiary care centre. A single-puncture dual-anchor gastropexy technique with a peel-away sheath was used for all patients. Complications within 30 day post-procedure were classified based on the Society of Interventional Radiology Standards of Practice for Gastrointestinal Access. Procedure-related mortality and complication rates, as well as indication-specific complication rates, were compared between GJ and G groups.
559 consecutive patients underwent G (86) or GJ (473) tube insertion. Primary technical success was 100%. Nine major (1.6%) and 60 minor (10.7%) complications occurred for an overall complication rate of 12.3%. The 30-day complication rate was significantly higher for GJ compared to G tube insertion (13.5% v. 5.8%, p = .049). There was a trend toward a higher 30-day minor complication rate for the GJ group (11.8% v. 4.7%, p = .057), but no significant difference between groups with respect to major complications (1.7% v. 1.2%, p = 1.0). Four procedure-related deaths occurred resulting in an overall procedure-related mortality of 0.7%. No significant difference in the procedure-related mortality was found between GJ and G groups (0.6% v. 1.2%, p = .49).
The 30-day major complication and procedure-related mortality rates from G and GJ tube insertion are low when using a single-puncture, dual-anchor gastropexy technique. GJ tube insertion is associated with a higher overall complication rate, likely due to more minor complications, but may avoid long-term adverse events.
我们的目标是评估使用单穿刺、双缝合锚定胃固定术和可剥离鞘技术进行经皮肠内喂养管插入术后30天的死亡率和并发症发生率。我们探讨了基于适应证以及胃造口术与胃空肠造口术管的并发症差异。
对2011年7月至2014年期间在一家三级医疗中心由五位介入放射科医生进行的透视引导下胃空肠造口术（GJ）和胃造口术（G）管插入术的成年患者进行回顾性研究。所有患者均采用带可剥离鞘的单穿刺双锚定胃固定术。术后30天内的并发症根据介入放射学会胃肠道通路实践标准进行分类。比较GJ组和G组的手术相关死亡率和并发症发生率以及特定适应证的并发症发生率。
559例连续患者接受了G管（86例）或GJ管（473例）插入术。主要技术成功率为100%。发生了9例严重并发症（1.6%）和60例轻微并发症（10.7%），总体并发症发生率为12.3%。与G管插入术相比，GJ管插入术的30天并发症发生率显著更高（13.5%对5.8%，p = 0.049）。GJ组30天轻微并发症发生率有升高趋势（11.8%对4.7%，p = 0.057），但两组在严重并发症方面无显著差异（1.7%对1.2%，p = 1.0）。发生了4例与手术相关的死亡，总体手术相关死亡率为0.7%。GJ组和G组在手术相关死亡率方面未发现显著差异（0.6%对1.2%，p = 0.49）。
使用单穿刺、双锚定胃固定术时，G管和GJ管插入术的30天严重并发症和手术相关死亡率较低。GJ管插入术总体并发症发生率较高，可能是由于轻微并发症较多，但可能避免长期不良事件。
