Featured

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

Presented During:

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

Final ID:

218 

Authors:

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

Institutions:

1Western University, London, Ontario

First Author:

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

Co-Author(s):

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

Purpose:

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

Materials:

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.

Results:

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.

Conclusions:

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

Keywords:

bedside procedures
Gastrostomy tube
Ultrasound guided