39 - How to Push Gastrostomy Tube – over the Balloon or Through the Peel-Away? Which Method Leads to More Reinterventions? Single Center Experience

Purpose: Number of Gastrostomies placed in USA per year is estimated at 250 000. Interventional Gastrostomy tube placement is performed in patients requiring long term enteral feeding. Indications for placement of push gastrostomies are malignancies and neurological disorders. Over the Balloon (OtB) and Peel Away (PA) techniques may be utilized for placement. Study was performed to assess reintervention rates of both placement methods.

Materials and Methods: Retrospective analysis was conducted on 63 patients in whom Push G tube placement was performed between 1.2024 and 8.2025. Only successful placements were included in the analysis. Patients included 26 females and 37 males. Mean age was 65, range from 27 to 93. Over the Balloon placement was used in 55 and through the Peel Away method was used in 8 patients. Standard us/fluoroscopy guidance with air insufflation was utilized. Gastropexy sutures were used in both groups (Cope Gastrointestinal Suture Anchor set, Cook Medical, Bloomington IA or Avanos Gastropexy Set Avanos Medical, Alpharetta, GA). Dorado PTA 10x40mm balloons (Bard, Tempe, AZ) , Peel-Away Introducer Sets (Cook Medical, Bloomington, IA) and MIC G tubes (Avanos, Alpharetta, GA) were used. Majority of the tubes used in OtB group were 16F (mean 16.07F). In the PA group 18F and 20F tubes were used (mean 18.74F). Evaluated were complications (mechanical and hemorrhagic), reintervention within 30 days and radiation exposure (Fluoroscopy time- FT and Air Kerma-AK). Statistical analysis was performed using T test.


Results: There was 0% mortality associated with placements. In the OtB group there were 11/57 reinterventions. Complications included obstruction of the tube (4), pull outs (4) and 3 cases of bleeding (IMA, LGA and pancreatic branch of splenic artery). None of the 8 patients in PA group had reintervention. In OtB group average FT was 5.9 min, average AK was 82 mGy . In PA group average FT was 4.5 min, average AK was 53 mGy.

Conclusion: Both methods are safe and effective in obtaining feeding access. Mechanical complications in the OtB group were G tube size related. While comparison shows better durability of the G tubes in Peel Away group, again it is most likely secondary to larger size of placed G Tube. Bleeding complications were not placement technique dependent. There were no significant differences in radiation times and exposure. Limitations of the study include short - 30-day - window and a small number of cases in Peel Away group. Additional evaluation of the other potential factors causing complications and increasing size of the sample is warranted.