Disc-retained tubes for radiologically inserted gastrostomy (RIG): not up to the job?
OBJECTIVE
To assess the insertion procedure and performance of disc-retained gastrostomy tubes, recording complications and accidental displacements by prospective audit, and to determine whether primary placement of the tube off-licence was feasible.


METHODS
Disc-retained 12 F single-lumen Monarch gastrostomy tubes (Enteral UK, Selby, UK) were inserted by three gastrointestinal interventional radiologists in a supra-regional cancer centre. The 12 F tubes required a 20 F peel-away sheath with four-point gastropexy fixation and were placed under conscious sedation, using electrocardiogram (EEG) bispectral index monitoring. Follow-up was performed in an in-house gastrostomy drop-in clinic at 1 week and 1 month, supplemented with weekly telephone follow-up. Patients also had open access to the gastrostomy drop-in clinic for immediate advice and complication management.


RESULTS
Eighteen patients underwent primary insertion of a Monarch gastrostomy tube over 5 months. A total of 6/18 (33%) tubes displaced; 4/18 (22%) completely, 2/18 (11%) occult into the peritoneum. Four of 18 (22%) patients developed infection at the stoma site. Due to the unexpectedly poor performance of the tube, the study was terminated early.


CONCLUSIONS
Initial experience with the Monarch disc-retained gastrostomy tube demonstrates it unsuitable for primary placement with current protocols. In view of the potentially serious complications, the Medicines and Healthcare Products Regulatory Agency (MHRA) has been informed. A request has been made to the distributer to reassess the tube design and/or review the procedure promoted for primary placement.
Department of Radiology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK. Electronic address: nabskib@yahoo.co.uk.
N
N
Kibriya
L
L
Wilbraham
D
D
Mullan
P
P
Puro
S
S
Vasileuskaya
D W
DW
Edwards
H-U
HU
Laasch
D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis / Q000379:methods* / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D059485:Gastropexy / Q000295:instrumentation; D005774:Gastrostomy / Q000295:instrumentation* / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*