Abdominal Radiology

, Volume 44, Issue 1, pp 318–326 | Cite as

Retrospective comparison of outcomes and associated complications between large bore radiologically inserted gastrostomy tube types

  • David J. Tischfield
  • Gregory J. Nadolski
  • Stephen J. Hunt
  • Maxim Itkin
  • Richard D. Shlansky-Goldberg
  • Terence P. GadeEmail author



Multiple approaches to radiologically inserted gastrostomy (RIG) exist. The goal of this study was to compare 30-day outcomes and associated complications between large bore balloon-retained (BR), loop-retained (LR), and pull-type (PT) RIG devices.


Data on 1477 patients who underwent RIG between January 1, 2005 and December 31, 2016 were collected retrospectively using a dedicated interventional radiology database and electronic medical record. Statistical analysis was performed to compare complication rates between BR, LR, and PT devices.


Ninety-eight percent (1477/1507) of the procedures were successfully performed. A total of 752 BR, 323 LR, and 402 PT gastrostomy tubes were placed. The overall complication rate for BR catheters was 5.7% (25 major [3.3%] and 18 minor [2.4%]). The overall complication rate for PT catheters was 3.7% (8 major [2.0%] and 7 minor [1.7%]). The overall complication rate for LR catheters was 1.6% (4 major [1.4%] and 1 minor [0.8%]). Compared to BR catheters, LR catheters had significantly fewer total complications (P = 0.01) but not minor complications (P = 0.052). There were no significant differences in the number of complications between LR and PT catheters or between BR and PT catheters.


Use of BR, LR, and PT devices for RIG is safe with a low incidence of complications. Compared to BR catheters, primary insertion of a LR gastrostomy was associated with significantly fewer overall complications within the first 30 days. Therefore, for initial tube placement, large bore LR catheters may be preferred over BR devices.


Radiologically inserted gastrostomy Balloon-retained Loop-retained Pull-type 









Radiologically inserted gastrostomy



We would like to thank Ivor Asztalos for help with statistical analyses.

Compliance with ethical standards

Conflict of interest

David J. Tischfield has no conflicts of interest. Gregory J. Nadolski reports grants from Guerbet, grants and personal fees from Teleflex, and grants from Lutonix, all outside the scope of the submitted work. Terence P. Gade has no conflicts of interest. Stephen J. Hunt reports personal fees from Amgen and BTG, all outside the scope of the submitted work. Richard D. Shlansky-Goldberg reports grants from BSC, all outside the scope of the submitted work. Maxim Itkin reports grants from Guerbet, all outside the scope of the submitted work.

Grant support and other assistance

The authors have no grants or funding sources to acknowledge.


  1. 1.
    Wollman B, D’Agostino HB, Walus-Wigle JR, Easter DW, Beale A (1995) Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology 197(3):699–704. CrossRefGoogle Scholar
  2. 2.
    de Baere T, Chapot R, Kuoch V, et al. (1999) Percutaneous gastrostomy with fluoroscopic guidance: single-center experience in 500 consecutive cancer patients. Radiology 210(3):651–654. CrossRefGoogle Scholar
  3. 3.
    Gutt CN, Held S, Paolucci V, Encke A (1996) Experiences with percutaneous endoscopic gastrostomy. World J Surg 20(8):1006–1008 (; discussion 108–9)CrossRefGoogle Scholar
  4. 4.
    Busch JD, Herrmann J, Adam G, Habermann CR (2016) Radiologically inserted gastrostomy: differences of maintenance of balloon- vs. loop-retained devices. Scand J Gastroenterol 51(12):1423–1428. CrossRefGoogle Scholar
  5. 5.
    Lowe AS, Laasch HU, Stephenson S, et al. (2012) Multicentre survey of radiologically inserted gastrostomy feeding tube (RIG) in the UK. Clin Radiol 67(9):843–854. CrossRefGoogle Scholar
  6. 6.
    Kuo YC, Shlansky-Goldberg RD, et al. (2008) Large or small bore, push or pull: a comparison of three classes of percutaneous fluoroscopic gastrostomy catheters. J Vasc Interv Radiol 19(4):557–563 (; quiz 64). CrossRefGoogle Scholar
  7. 7.
    Funaki B, Peirce R, Lorenz J, et al. (2001) Comparison of balloon- and mushroom-retained large-bore gastrostomy catheters. AJR Am J Roentgenol 177(2):359–362. CrossRefGoogle Scholar
  8. 8.
    Funaki B, Zaleski GX, Lorenz J, et al. (2000) Radiologic gastrostomy placement: pigtail- versus mushroom-retained catheters. AJR Am J Roentgenol 175(2):375–379. CrossRefGoogle Scholar
  9. 9.
    Yang Y, Schneider J, Duber C, Pitton MB (2011) Comparison of fluoroscopy-guided Pull-type percutaneous radiological gastrostomy (pull-type-PRG) with conventional percutaneous radiological gastrostomy (push-type-PRG): clinical results in 253 patients. Eur Radiol 21(11):2354–2361. CrossRefGoogle Scholar
  10. 10.
    Laasch HU, Wilbraham L, Bullen K, et al. (2003) Gastrostomy insertion: comparing the options—PEG, RIG or PIG? Clin Radiol 58(5):398–405CrossRefGoogle Scholar
  11. 11.
    Bernstein OA, Campbell J, Rajan DK, et al. (2015) Randomized trial comparing radiologic pigtail gastrostomy and peroral image-guided gastrostomy: intra- and postprocedural pain, radiation exposure, complications, and quality of life. J Vasc Interv Radiol 26(11):1680–1686 (; quiz 6). CrossRefGoogle Scholar
  12. 12.
    Han K, Kim MD, Kwon JH, et al. (2017) Randomized controlled trial comparing radiologic pigtail-retained gastrostomy and radiologic mushroom-retained gastrostomy. J Vasc Interv Radiol . Google Scholar
  13. 13.
    Omary RA, Bettmann MA, Cardella JF, et al. (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14(9 Pt 2):S293–S295CrossRefGoogle Scholar
  14. 14.
    Brown AS, Mueller PR, Ferrucci JT Jr (1986) Controlled percutaneous gastrostomy: nylon T-fastener for fixation of the anterior gastric wall. Radiology 158(2):543–545. CrossRefGoogle Scholar
  15. 15.
    Szymski GX, Albazzaz AN, Funaki B, et al. (1997) Radiologically guided placement of pull-type gastrostomy tubes. Radiology 205(3):669–673. CrossRefGoogle Scholar
  16. 16.
    Gauderer MW, Ponsky JL, Izant RJ Jr (1980) Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15(6):872–875CrossRefGoogle Scholar
  17. 17.
    Preshaw RM (1981) A percutaneous method for inserting a feeding gastrostomy tube. Surg Gynecol Obstet 152(5):658–660Google Scholar
  18. 18.
    Ho CS (1983) Percutaneous gastrostomy for jejunal feeding. Radiology 149(2):595–596. CrossRefGoogle Scholar
  19. 19.
    Tao HH, Gillies RR (1983) Percutaneous feeding gastrostomy. AJR Am J Roentgenol 141(4):793–794. CrossRefGoogle Scholar
  20. 20.
    Wills JS, Oglesby JT (1983) Percutaneous gastrostomy. Radiology 149(2):449–453. CrossRefGoogle Scholar
  21. 21.
    Shin JH, Park AW (2010) Updates on percutaneous radiologic gastrostomy/gastrojejunostomy and jejunostomy. Gut Liver 4(Suppl 1):S25–S31. CrossRefGoogle Scholar
  22. 22.
    Dormann AJ, Wejda B, Kahl S, et al. (2006) Long-term results with a new introducer method with gastropexy for percutaneous endoscopic gastrostomy. Am J Gastroenterol 101(6):1229–1234. CrossRefGoogle Scholar
  23. 23.
    Given MF, Hanson JJ, Lee MJ (2005) Interventional radiology techniques for provision of enteral feeding. Cardiovasc Intervent Radiol 28(6):692–703. CrossRefGoogle Scholar
  24. 24.
    Lim JH, Choi SH, Lee C, et al. (2016) Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 14(4):333–342. CrossRefGoogle Scholar
  25. 25.
    Stern JS (1986) Comparison of percutaneous endoscopic gastrostomy with surgical gastrostomy at a community hospital. Am J Gastroenterol 81(12):1171–1173Google Scholar
  26. 26.
    Cosentini EP, Sautner T, Gnant M, et al. (1998) Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies. Arch Surg 133(10):1076–1083CrossRefGoogle Scholar
  27. 27.
    Grant DG, Bradley PT, Pothier DD, et al. (2009) Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 34(2):103–112. CrossRefGoogle Scholar
  28. 28.
    Moller P, Lindberg CG, Zilling T (1999) Gastrostomy by various techniques: evaluation of indications, outcome, and complications. Scand J Gastroenterol 34(10):1050–1054CrossRefGoogle Scholar
  29. 29.
    Silas AM, Pearce LF, Lestina LS, et al. (2005) Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: a comparison of indications, complications and outcomes in 370 patients. Eur J Radiol 56(1):84–90. CrossRefGoogle Scholar
  30. 30.
    MacLean AA, Alvarez NR, Davies JD, Lopez PP, Pizano LR (2007) Complications of percutaneous endoscopic and fluoroscopic gastrostomy tube insertion procedures in 378 patients. Gastroenterol Nurs 30(5):337–341. CrossRefGoogle Scholar
  31. 31.
    Galletti R, Finocchiaro E, Repici A, Saracco G, Zanardi M (2001) Comparison of complication rates between endoscopic and fluoroscopic percutaneous gastrostomies. Nutrition 17(11–12):967–968CrossRefGoogle Scholar
  32. 32.
    Leeds JS, McAlindon ME, Grant J, et al. (2010) Survival analysis after gastrostomy: a single-centre, observational study comparing radiological and endoscopic insertion. Eur J Gastroenterol Hepatol 22(5):591–596. CrossRefGoogle Scholar
  33. 33.
    Sofue K, Takeuchi Y, Tsurusaki M, et al. (2016) Value of percutaneous radiologic gastrostomy for patients with advanced esophageal cancer. Ann Surg Oncol 23(11):3623–3631. CrossRefGoogle Scholar
  34. 34.
    Yip D, Vanasco M, Funaki B (2004) Complication rates and patency of radiologically guided mushroom gastrostomy, balloon gastrostomy, and gastrojejunostomy: a review of 250 procedures. Cardiovasc Intervent Radiol 27(1):3–8. CrossRefGoogle Scholar
  35. 35.
    Sutcliffe J, Wigham A, McEniff N, et al. (2016) CIRSE standards of practice guidelines on gastrostomy. Cardiovasc Intervent Radiol 39(7):973–987. CrossRefGoogle Scholar
  36. 36.
    Huang AT, Georgolios A, Espino S, et al. (2013) Percutaneous endoscopic gastrostomy site metastasis from head and neck squamous cell carcinoma: case series and literature review. J Otolaryngol Head Neck Surg 42:20. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • David J. Tischfield
    • 1
    • 2
  • Gregory J. Nadolski
    • 1
    • 2
  • Stephen J. Hunt
    • 1
    • 2
    • 3
  • Maxim Itkin
    • 1
  • Richard D. Shlansky-Goldberg
    • 1
  • Terence P. Gade
    • 1
    • 2
    • 3
    Email author
  1. 1.Division of Interventional Radiology, Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Penn Image-Guided Interventions LaboratoryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaUSA

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