Gastrostomy Tube Placement by Radiological Methods for Older Patients Requiring Enteral Nutrition: Not to be Forgotten

Vered Hermush; Yitshal Berner; Yael Katz; Yanina Kunin; Irena Krasniansky; Yael Schwartz; Debbie Mimran Nahon; Ana Elizariev; Gad Mendelson

doi:10.3389/fmed.2018.00274

Gastrostomy Tube Placement by Radiological Methods for Older Patients Requiring Enteral Nutrition: Not to be Forgotten

Front Med (Lausanne). 2018 Sep 26:5:274. doi: 10.3389/fmed.2018.00274. eCollection 2018.

Authors

Vered Hermush^{1

2}, Yitshal Berner³, Yael Katz^{2

4}, Yanina Kunin^{2

4}, Irena Krasniansky^{2

4}, Yael Schwartz^{1

2}, Debbie Mimran Nahon^{2

4}, Ana Elizariev^{1

2}, Gad Mendelson^{2

4}

Affiliations

¹ Department of Geriatrics and Skilled Nursing, Laniado Medical Center, Netanya, Israel.
² Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel.
³ Department of Geriatric Medicine, Meir Medical Center, Kfar Saba and Sackler Medical School, Tel Aviv University, Kfar Saba, Israel.
⁴ Dorot Geriatric and Rehabilitation Center, Netanya, Israel.

Abstract

Background: The use of gastrostomy tubes for long-term nutritional support in older patients is frequent. Percutaneous gastrostomy tube placement may be performed using various techniques, including endoscopic, surgical, and radiologically-guided methods. While percutaneous endoscopic gastrostomy (PEG) placement is the most widely used and accepted approach, experience with the use of percutaneous radiological gastrostomy (PRG) is more limited. Objective: To evaluate the safety and short-term outcomes of PRG in older patients requiring long-term enteral feeding. Method: We performed a prospective study involving all patients aged 65 years and older who underwent PRG insertion at the Laniado hospital over a period of 2 years. Adverse events related to the gastrostomy tube insertion were recorded over a period of 3 months following the procedure. Results: A total of 58 patients were included with a mean age of 78.1 years, and 48% were women. The most frequent indications for enteral feeding were stroke (47%) and dementia (41%). The technical success rate was 100% with no immediate procedure-related mortality or morbidity. One-month mortality was 3%, and overall mortality at 3-month follow-up was 16%. Complications were reported in 39 (67%) of patients, with 17 (29%) experiencing more than 1 complication. While most complications (88%) were minor, major complications occurred in 19 (33%) of the patients. Peritonitis was the cause of death in 2 patients, and tube dislodgment occurred in 17 subjects. During the follow-up period 17 (29%) of patients were re-admitted to hospital, with the cause for re-hospitalization being unrelated to the PRG in half of the cases. Neither bleeding nor deep wound infection was detected in the study group. Conclusions: PRG is relatively safe and effective for gastrostomy placement in older patients, and this technique may be of value in patients with oral infections and those receiving anti-thrombotic therapy.

Keywords: elderly; enteral nutrition; feeding tube; percutaneous radiological gastrostomy; survival.