Factors Contributing to Persistent Gastropexy Following Gastrostomy Tube Removal: Considerations for Future Gastric Interventions.

Gastro-cutaneous tracts from gastrostomy tubes typically close spontaneously within 4 to 72 hours following tube removal. The tract forms a scar, which appears as dimpled cutaneous tissue. This scar can retract to the peritoneal entry site, resulting in a pinpoint gastropexy visible on ultrasound (US) and potentially re-cannulated. However, factors influencing the development of an accessible scar tract remain unclear.

Materials and Methods:

This single-center retrospective study examines patterns of residual gastropexy on cross-sectional imaging in patients with a history of removed gastrostomy tubes. Patients were categorized as having a residual gastropexy scar or an obliterated scar tract. Factors analyzed included G-tube duration, number of T-fasteners, ventral stomach position change (delta antrum), and BMI. Spearman’s rank correlation coefficient was used to analyze these factors and demographic data.

Results:

A total of 71 patients with percutaneous gastrostomy tubes and cross-sectional imaging (CT Abdomen, CT Chest, or FDG PET/CT) before and after tube removal were reviewed. All patients had a visible scar tract on initial post-removal images. Of these, 67% (48/71) had a retained gastropexy, defined as gastric wall retraction to the peritoneal entry site, while 33% (23/71) had no residual gastropexy. The mean G-tube duration was 6.6 months in the retained group versus 4.3 months in the non-retained group. Patients with a G-tube for over 6 months were 65% more likely to retain a gastropexy (p=0.02). Three patients lost gastropexy on later interval imaging, with a mean duration of 36 months. Displacement of adjacent transverse colon was noted in 71% (34/48) of retained cases. T-fasteners and BMI showed no significant difference between groups. Patients with retained gastropexy had a delta antrum less than 20 mm more frequently than those without retention. Three patients underwent G-tube replacement via sharp recanalization of the scar tract under US guidance.

Conclusion:

G-tube duration significantly affects gastropexy retention after removal. Gastropexy-related displacement of the stomach and adjacent intestine showed no negative clinical impact. Recanalization through a visible scar tract was feasible. Further research is needed to assess long-term gastropexy durability beyond 36 months.