First-in-human clinical experience with percutaneous ultrasound gastrostomy (PUG)

Presented During:

Sat, 6/13/2020: 1:17 PM  - 1:26 PM 
Room: Webinar  

Final ID:



D Cool1, J Chung1, D Wiseman1, S Kribs1, A Mujoomdar1


1Western University, London, Ontario

First Author:

Derek W. Cool, MD, PHD  
Western University
London, Ontario


Jonathan Chung  
Western University
London, Ontario
Daniele Wiseman  
Western University
London, Ontario
Stewart W. Kribs, MD  
Western University
London, Ontario
Amol Mujoomdar, MD  
Western University
London, Ontario

Presenting Author:

Derek W. Cool, MD, PHD  
Western University
London, Ontario


To describe the first-in-human experience with a new technology that allows gastrostomy tube insertion using only ultrasound guidance.


An ongoing single-center, prospective safety and efficacy study is being performed under institutional and Health Canada approval using a new device developed for percutaneous ultrasound gastrostomy (PUG) tube insertion. The PUMA-G system (CoapTech, Baltimore, MD) forms a magnetic gastropexy by inserting into the stomach an orogastric balloon catheter (OBC) with a magnet at the tip and placing an external magnet on the epigastrium to achieve magnet coaptation with the OBC. The water-filled OBC balloon is punctured through the abdominal wall under ultrasound guidance and used to snare an inserted wire that is pulled out the mouth for standard per-oral gastrostomy tube insertion. Exclusion criteria include: age <18 years, BMI >30 or <20, heart rate >110, contraindication to magnet (e.g. pacemaker), active bleeding, prior gastrostomy or gastrectomy, pregnancy or a medical condition putting a patient at risk for PUG insertion. Clinical follow-up was performed at baseline, 2 days & 30 days post-PUG insertion.


13 patients (12 male, median age 62±13 years, BMI 24.6±2.3) were enrolled and 12 patients completed 30-day follow-up. All PUG insertions were successfully performed under conscious sedation (Midazolam 2.3±1.3mg, Fentanyl 112±68μg). 6 cases were performed solely under ultrasound guidance, including one performed bedside in the ICU. 7 cases required fluoroscopy only to confirm the OBC location within the stomach for magnetic gastropexy. Median procedure time was 40±14 min (range 16-71) with the most time spent trying to achieve magnetic coaptation (27 min). The final 4 cases utilized a small Gauss meter to detect the OBC position within the stomach resulting in a trend toward faster coaptation time (18±5 vs. 33±14 min). 1 major (pericatheter subcutaneous abscess) and 2 minor complications (pericatheter cellulitis, minor aspiration 2 days post-insertion) occurred within the 30-day follow-up.


The PUG technique is safe, feasible and could allow interventional radiologists to perform gastrostomy insertions outside of the angiosuite.

Abstract Categories:

Non-Vascular Interventions: Gastrointestinal


bedside procedures
Gastrostomy tube
Ultrasound guided