Radiologic gastrostomy placement: Pigtail-versus mushroom-retained catheters

OBJECTIVE, Two different types of percutaneous fluoroscopic gastrostomy pro cedures were prospectively evaluated. SUBJECTS AND METHODS, Between January 1, 1998, and August 10, 1999, 127 per cutaneous gastrostomy catheters were placed in 128 patients in 128 attempts . Seventy-five 12- or 14-French pigtail-retained catheters and fifty-two 20 -French mushroom-retained catheters were inserted. Catheters were generally placed on the basis of operator preference except pigtail-retained tubes w ere preferentially placed in patients with head and neck or esophageal mali gnancies and mushroom-retained catheters were preferentially placed in neur ologically compromised or combative patients. The technical success, proced ural complications, and catheter complications were recorded. Statistical a nalysis was performed. RESULTS. Ninety-nine percent (127/128) of the procedures were successful, a nd there were no procedural complications. One catheter was not placed beca use the colon intervened between the abdominal wall and stomach. In patient s who received pigtail-retained catheters, the major complication rate was 3% (2/75), the minor complication rate was 8% (6/75), and the tube complica tion rate was 36% (27/75). The following complications were seen: tube oc e lusion (n = 12), inadvertent catheter removal (n = 8), peristomal tube leak age (n = 7), superficial cellulitis (n = 4). aspiration pneumonia (n = 2), and T-fastener cellulitis (n = 2). In patients who received mushroom-retain ed catheters, the major complication rate was 0%, the minor complication ra te was 2% (1/52), and the tube complication rate was 2% (1/52). Complicatio ns were superficial cellulitis (n = 1) and partial catheter fracture (n = 1 ). There were no significant differences in major and minor complications b etween procedures. Pigtail-retained catheters had a significantly higher ra te of tube complications (p < 0.001) CONCLUSION. Compared with pigtail-retained catheters, mushroom-retained gas trostomy catheters are more durable and secure and are less prone to tube d ysfunction. These catheters should be preferentially placed when possible.