Fluoroscopically guided percutaneous gastrostomy: is gastric fixation necessary?

In this animal study the authors evaluated the safety of inserting gastrostomy catheters percutaneously without the aid of gastric fixation. In a laboratory model (excised dog stomachs) there was not leakage around gastrostomy tubes of different sizes (nos. 8 to 18 French), despite maximum gastric distension and intragastric pressures of up to 100 mm Hg. When the tubes were removed, the risk of leakage from the gastrostomy increased in proportion to the size of the gastric defect. Percutaneous gastrostomy catheters (no. 14 French) were then placed in five live dogs without gastric fixation and were immediately withdrawn. All animals remained well. Autopsies performed 7 days later showed no evidence of leakage. The authors conclude that there is no leakage around correctly placed gastrostomy tubes. Although gastric defects larger than no. 10 French leak easily in vitro, a defect of no. 14 French is well tolerated in vivo. The authors suggest that percutaneous gastrostomy may be performed safely without gastric fixation devices in patients as long as the size of the initial cathether used is no. 14 French or smaller.