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Technical Brief

Percutaneous Ultrasound Gastrostomy: A Novel Device and Bedside Procedure for Gastrostomy Tube Insertion Using Magnetic and Ultrasound Guidance

[+] Author and Article Information
R. Gentry Wilkerson

Department of Emergency Medicine,
School of Medicine,
University of Maryland,
110 South Paca Street, 6th Floor, Suite 200,
Baltimore, MD 21201
e-mail: gwilkerson@som.umaryland.edu

Aliaksei Pustavoitau

Department of Anesthesiology and Critical Care Medicine,
School of Medicine,
Johns Hopkins University,
600 North Wolfe Street, Meyer 297,
Baltimore, MD 21287
e-mail: apustav1@jhmi.edu

Howard Carolan

Armstrong Institute for Patient Safety and Quality,
School of Medicine,
Johns Hopkins University,
750 East Pratt Street, 15th Floor,
Baltimore, MD 21202
e-mail: howard@coaptech.com

Nolan Benner

School of Engineering,
Johns Hopkins University,
Baltimore, MD 21218
e-mail: nbenner1@jhu.edu

Clark Fischer

School of Engineering,
Johns Hopkins University,
Baltimore, MD 21218
e-mail: clarkfischer@jhu.edu

Daniel J. Sheets

Department of Emergency Medicine,
School of Medicine,
University of Maryland,
110 South Paca Street, 6th Floor, Suite 200,
Baltimore, MD 21201
e-mail: dsheets@som.umaryland.edu

Peggy I. Wang

CoapTech,
8 Market Place Suite 804,
Baltimore, MD 21202
e-mail: wang.peggy@gmail.com

Steven Tropello

Department of Emergency Medicine,
School of Medicine,
University of Maryland,
110 South Paca Street, 6th Floor, Suite 200,
Baltimore, MD 21201
e-mail: stropello@som.umaryland.edu

1Corresponding author.

Manuscript received July 31, 2018; final manuscript received January 13, 2019; published online March 6, 2019. Assoc. Editor: Carl Nelson.

J. Med. Devices 13(2), 024501 (Mar 06, 2019) (6 pages) Paper No: MED-18-1123; doi: 10.1115/1.4042866 History: Received July 31, 2018; Revised January 13, 2019

This paper describes a novel percutaneous ultrasound gastrostomy (PUG) procedure and the CoapTech point-of-care ultrasound magnet-aligned gastrostomy (PUMA-G) device, which were developed to allow the placement of gastrostomy tubes by physicians across a variety of specialties, using ultrasound equipment found in many nonspecialized medical locations while consuming fewer resources. The current practice for the placement of gastrostomy tubes requires highly specialized equipment and trained physicians, which can delay the performance of the procedure or make it inaccessible in some locations. The PUMA-G device consists of an orogastric catheter with a balloon that encloses a magnetic bar at its distal end and an external, handheld magnet. The orogastric tube is passed through the mouth or the nose and into the stomach. The external magnet is then used to maneuver the balloon to the desired location in the stomach, with feedback and guidance from real-time ultrasound visualization. The novelty of this approach is the use of magnets to create the static compressive force needed for coaptation, in which the stomach is pushed flush against the abdominal wall, allowing ultrasound visualization of the entire gastrostomy tract (skin to stomach), safe cutaneous puncture, and guidewire-assisted placement of the gastrostomy tube. The development of the PUMA-G device has been aided by benchtop and simulation testing in addition to canine and human cadaver studies. The PUMA-G device was used successfully in 29 of 30 cadaver tests, with the one failure attributed to operator error and not the device. Further testing in live patients will assess the safety of the procedure, the speed with which it can be completed, the cost savings, and other benefits the device might offer over the existing gastrostomy procedures.

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References

Rahnemai-Azar, A. A. , Rahnemaiazar, A. A. , Naghshizadian, R. , Kurtz, A. , and Farkas, D. T. , 2014, “ Percutaneous Endoscopic Gastrostomy: Indications, Technique, Complications and Management,” World J. Gastroenterol., 20(24), pp. 7739–7751. [CrossRef] [PubMed]
Roche, V. , 2003, “ Percutaneous Endoscopic Gastrostomy: Clinical Care of PEG Tubes in Older Adults,” Geriatrics, 58(11), pp. 22–26. [PubMed]
Goldberg, E. , Kaye, R. , Yaworski, J. , and Liacouras, C. , 2005, “ Gastrostomy Tubes: Facts, Fallacies, Fistulas, and False Tracts,” Gastroenterol. Nurs., 28(6), pp. 485–494. [CrossRef] [PubMed]
Lynch, C. R. , and Fang, J. C. , 2004, “ Prevention and Management of Complications of Percutaneous Endoscopic Gastrostomy (PEG) Tubes,” Pract. Gastroenterol., 28(11), pp. 66–76. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.458.1001&rep=rep1&type=pdf
Gauderer, M. W. , Ponsky, J. L. , and Izant, R. J. , 1980, “ Gastrostomy Without Laparotomy: A Percutaneous Endoscopic Technique,” J. Pediatr. Surg., 15(6), pp. 872–875. [CrossRef] [PubMed]
Sacks, B. A. , Vine, H. S. , Palestrant, A. M. , Ellison, H. P. , Shropshire, D. , and Lowe, R. , 1983, “ A Nonoperative Technique for Establishment of a Gastrostomy in the Dog,” Invest. Radiol., 18(5), pp. 485–487. [CrossRef] [PubMed]
Köhler, G. , Kalcher, V. , Koch, O. O. , Luketina, R.-R. , Emmanuel, K. , and Spaun, G. , 2015, “ Comparison of 231 Patients Receiving Either ‘Pull-Through’ or ‘Push’ Percutaneous Endoscopic Gastrostomy,” Surg. Endoscopy, 29(1), pp. 170–175. [CrossRef]
Blumenstein, I. , Shastri, Y. M. , and Stein, J. , 2014, “ Gastroenteric Tube Feeding: Techniques, Problems and Solutions,” World J. Gastroenterol., 20(26), pp. 8505–8524. [CrossRef] [PubMed]
Vervloessem, D. , van Leersum, F. , Boer, D. , Hop, W. C. J. , Escher, J. C. , Madern, G. C. , de Ridder, L. , and Bax, K. N. M. A. , 2009, “ Percutaneous Endoscopic Gastrostomy (PEG) in Children Is Not a Minor Procedure: Risk Factors for Major Complications,” Semin. Pediatr. Surg., 18(2), pp. 93–97. [CrossRef] [PubMed]
Zamakhshary, M. , Jamal, M. , Blair, G. K. , Murphy, J. J. , Webber, E. M. , and Skarsgard, E. D. , 2005, “ Laparoscopic Versus Percutaneous Endoscopic Gastrostomy Tube Insertion: A New Pediatric Gold Standard?,” J. Pediatr. Surg., 40(5), pp. 859–862. [CrossRef] [PubMed]
Nah, S. A. , Narayanaswamy, B. , Eaton, S. , De Coppi, P. , Kiely, E. M. , Curry, J. I. , Drake, D. P. , Barnacle, A. M. , Roebuck, D. J. , and Pierro, A. , 2010, “ Gastrostomy Insertion in Children: Percutaneous Endoscopic or Percutaneous Image-Guided?,” J. Pediatr. Surg., 45(6), pp. 1153–1158. [CrossRef] [PubMed]
Shah, R. D. , Tariq, N. , Shanley, C. , Robbins, J. , and Janczyk, R. , 2009, “ Peritonitis From Peg Tube Insertion in Surgical Intensive Care Unit Patients: Identification of Risk Factors and Clinical Outcomes,” Surg Endosc., 23(11), pp. 2580–2586.
ProCESS Investigators, 2014, “ A Randomized Trial of Protocol-Based Care for Early Septic Shock,” New Engl. J. Med., 370(18), pp. 1683–1693. [CrossRef]
Callahan, C. M. , Buchanan, N. N. , and Stump, T. E. , 2001, “ Healthcare Costs Associated With Percutaneous Endoscopic Gastrostomy Among Older Adults in a Defined Community,” J. Am. Geriatr. Soc., 49(11), pp. 1525–1529. [CrossRef] [PubMed]
Day, L. W. , and Belson, D. , 2015, “ Studying and Incorporating Efficiency Into Gastrointestinal Endoscopy Centers,” Gastroenterol. Res. Pract., 2015, p. 764153. [CrossRef] [PubMed]
Shin, J. H. , and Park, A. W. , 2010, “ Updates on Percutaneous Radiologic Gastrostomy/Gastrojejunostomy and Jejunostomy,” Gut Liver, 4(Suppl. 1), pp. S25–S31. [CrossRef] [PubMed]
Tsukuda, T. , Fujita, T. , Ito, K. , Yamashita, T. , and Matsunaga, N. , 2006, “ Percutaneous Radiologic Gastrostomy Using Push-Type Gastrostomy Tubes With CT and Fluoroscopic Guidance,” Am. J. Roentgenol., 186(2), pp. 574–576. [CrossRef]
Laasch, H. U. , and Martin, D. F. , 2007, “ Radiologic Gastrostomy,” Endoscopy, 39(3), pp. 247–255. [CrossRef] [PubMed]
Akers, A. S. , and Pinsky, M. , 2017, “ Placement of a Magnetic Small Bowel Feeding Tube at the Bedside,” J. Parenter. Nutr., 41(3), pp. 496–499. [CrossRef]
Smithard, D. , Barrett, N. A. , Hargroves, D. , and Elliot, S. , 2015, “ Electromagnetic Sensor-Guided Enteral Access Systems: A Literature Review,” Dysphagia, 30(3), pp. 275–285. [CrossRef] [PubMed]
Dressman, J. B. , 1986, “ Comparison of Canine and Human Gastrointestinal Physiology,” Pharm. Res., 3(3), pp. 123–131. [CrossRef] [PubMed]
McGarr, S. E. , and Kirby, D. F. , 2007, “ Percutaneous Endoscopic Gastrostomy (PEG) Placement in the Overweight and Obese Patient,” J. Parenter. Nutr., 31(3), pp. 212–216. [CrossRef]
Dennis, B. , and Gunter, O. , 2013, “ Surgical Procedures in the Intensive Care Unit: A Critical Review,” OA Crit. Care, 1(1), p. 6. http://www.oapublishinglondon.com/article/679
Mirski, M. , Pandian, V. , Bhatti, N. , Haut, E. , Feller-Kopman, D. , Morad, A. , Haider, A. , Schiavi, A. , Efron, D. , and Ulatowski, J. , 2012, “ Safety, Efficiency, and Cost-Effectiveness of a Multidisciplinary Percutaneous Tracheostomy Program,” Crit. Care Med., 40(6), pp. 1827–1834. [CrossRef] [PubMed]

Figures

Grahic Jump Location
Fig. 1

The GTB: an orogastric tube that at its distal end has a balloon that encloses a bar magnet

Grahic Jump Location
Fig. 2

External handheld adapter

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Fig. 3

Needle access of GTB with guidewire

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Fig. 4

Clinical workflow of PUG procedure

Grahic Jump Location
Fig. 5

Canine testing endoscopy images for three- and sixfold strength magnets

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