title: Massive reflux and aspiration after radiographically inserted gastrostomy tube placement.
abstract: To the authors' knowledge, fatal postgastrostomy aspiration within 2 days of enteral nutrition has not been reported. The authors report consecutive cases of severe postgastrotomy aspiration with one being fatal for a 26-yr-old with Duchenne muscular dystrophy 2 days after initiation of gastrostomy feedings. Previous to these consecutive radiographically inserted gastrostomies, all gastrotomies at the institution were percutaneous endoscopic gastrostomies or open gastrostomies. Radiographically inserted gastrostomy tubes have an increased likelihood of being oriented toward the esophagus as opposed to the duodenum, which may increase the risk for reflux. Elimination of invasive airway tubes should be delayed until after gastrostomy feedings are documented to be well tolerated. Oximetry and repeated measurements of vital capacity can suggest changes in the status of airway clearance.
authors.affiliation: From the Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark (SAC, JRB); and Camargo Cancer Center, Saō Paulo, Brazil (EMO).
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Chesoni
authors.forename: John R
authors.initials: JR
authors.lastname: Bach
authors.forename: Erica Mie
authors.initials: EM
authors.lastname: Okumura
mesh_terms: D000328:Adult; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D017809:Fatal Outcome; D005764:Gastroesophageal Reflux / Q000209:etiology*; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000628:therapy*; D011015:Pneumonia, Aspiration / Q000209:etiology; D015641:Radiography, Interventional / Q000009:adverse effects* / Q000379:methods