O15 Benefits of gastrostomy tract dilatation following gastrostomy tube displacement
Published Date: 19th June 2022
Publication Authors: Roberts S, Theis V, Clark K
Introduction
It is estimated that 2% of gastrostomies will become displaced in the first 10 months of placement and 37% within five years.1 Replacement of a displaced gastrostomy tube should only be attempted 4 weeks after initial placement, as prior to this, the tract may not be fully formed and the risk of misplacement is high. Gastrostomy tracts can close quickly and become difficult to replace the longer it is left. It is therefore vital that these tubes are replaced as quickly as possible if displaced.
Between February 2017 and January 2018, nine patients were admitted to a DGH following PEG displacement requiring endoscopic replacement due to tract closure. Inpatient stays ranged from 2–14 days with a total of 41 bed days, 2 theatre slots and 7 endoscopy slots used. The average inpatient stay for PEG replacements was 4.5 days.
Methods
Nasogastric tubes were used by a Nutrition Specialist Nurse to incrementally dilate stenosed gastrostomy tracts; starting at 8fr and increasing sequentially in 2fr increments up to 14fr. A retrospective review between March 2018 and October 2020 evaluated the use of gastrostomy tract dilatation in relation to its effect on patient outcomes and inpatient stay.
Results
During the study period, 34 patients required gastrostomy tube replacement due to accidental removal. 14 of these required no tract dilatation prior to replacement of their balloon gastrostomy tube, 20 required gastrostomy tract dilatation to avoid need for endoscopic or radiological replacement. Of the 20 requiring gastrostomy tract dilatation, 15 of the gastrostomy tubes were confirmed in position using pH following successful bedside insertion. Five attempts to dilate were unsuccessful and resulted in the tracts being re-established by interventional radiology and avoided new RIG/PEG tubes. Of the 20 patients in whom tract dilatation was attempted, the success rate was 75% allowing these patients to be immediately discharged and recommenced on enteral feeding without further intervention.
Conclusion
Gastrostomy tract dilatation is an effective and quick way of reinserting gastrostomy tubes that have been out for a prolonged time resulting in tract stenosis. This technique can reduce inpatient stays (with associated cost savings), avoid the risks associated with further endoscopy and radiological interventions and enable rapid re-establishment of enteral feeding. The success rate is high and although there are risks of tract, one study suggests that 7.3% of routine tube changes also result in tract displacement.2 Given the success of this, the training has been rolled out to medical staff in the Accident and Emergency Department to carry out this intervention which will ensure that patients spend even less time in the emergency department and be discharged in a timely manner, preventing the need for admission, particularly over the weekend when there is no Nutrition Specialist Nurse cover.
References
- Bhambani S, Phan TH, Brown L, Thorp AW. Replacement of dislodged gastrostomy tubes after stoma dilation in the pediatric emergency department. Western Journal of Emergency Medicine 2017;18(4):770–775.
- DiBaise JK, Rentz L, Crowell MD, Decker GA, Lunsford T. (2010) Tract disruption and external displacement following gastrostomy tube exchange in adults.
Roberts, S; Theis, V; Clark, K. (2022). O15 Benefits of gastrostomy tract dilatation following gastrostomy tube displacement. GUT. 71(Suppl 1), pp.A8-A9. [Online]. Available at: https://gut.bmj.com/content/71/Suppl_1/A8.2 [Accessed 16 September 2022]
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