title: Gastrostomy tube placement without nasogastric tube: a retrospective evaluation in 85 patients.
abstract: OBJECTIVE
  Our study evaluated techniques for percutaneous gastrostomy (G)-tube placement without the use of a nasogastric (NG) tube. Instead, direct puncture of a physiologic air bubble or effervescent-enhanced gastric bubble distention was performed in patients with upper digestive tract obstruction (UDTO) or psychological objections to NG tubes.
  
  
  METHODS
  A total of 886 patients underwent G-tube placement in our department during a period of 7 years. We present our series of 85 (9.6%) consecutive patients who underwent percutaneous G-tube placement without use of an NG tube.
  
  
  RESULTS
  Of these 85 patients, fluoroscopic guided access was attempted by direct puncture of a physiologically present gastric air bubble in 24 (28%) cases. Puncture of an effervescent-induced large gastric air bubble was performed in 61 (72%) patients. Altogether, 82 (97%) of 85 G tubes were successfully placed in this fashion. The three failures comprised refusal of effervescent, vomiting of effervescent, and one initial tube misplacement when a deviation from our standard technique occurred.
  
  
  CONCLUSIONS
  The described techniques compare favorably with published large series on G-tube placement with an NG tube in place. The techniques are especially suited for patients with UDTO due to head, neck, or esophageal malignancies, but they should be considered as an alternative in all patients. Direct puncture of effervescent-enhanced gastric bubble distention is a safe, patient-friendly and effective technique.
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. weheberlein@uams.edu
authors.forename: Wolf E
authors.initials: WE
authors.lastname: Heberlein
authors.forename: Whitney J
authors.initials: WJ
authors.lastname: Goodwin
authors.forename: Clint E
authors.initials: CE
authors.lastname: Wood
authors.forename: Muhammad
authors.initials: M
authors.lastname: Yousaf
authors.forename: William C
authors.initials: WC
authors.lastname: Culp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001466:Barium Sulfate / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D015641:Radiography, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate