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.

References

References
1.
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
.
2.
Roche
,
V.
,
2003
, “
Percutaneous Endoscopic Gastrostomy: Clinical Care of PEG Tubes in Older Adults
,”
Geriatrics
,
58
(
11
), pp.
22
26
.
3.
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
.
4.
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
5.
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
.
6.
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
.
7.
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
.
8.
Blumenstein
,
I.
,
Shastri
,
Y. M.
, and
Stein
,
J.
,
2014
, “
Gastroenteric Tube Feeding: Techniques, Problems and Solutions
,”
World J. Gastroenterol.
,
20
(
26
), pp.
8505
8524
.
9.
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
.
10.
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
.
11.
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
.
12.
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.
13.
ProCESS Investigators
,
2014
, “
A Randomized Trial of Protocol-Based Care for Early Septic Shock
,”
New Engl. J. Med.
,
370
(
18
), pp.
1683
1693
.
14.
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
.
15.
Day
,
L. W.
, and
Belson
,
D.
,
2015
, “
Studying and Incorporating Efficiency Into Gastrointestinal Endoscopy Centers
,”
Gastroenterol. Res. Pract.
,
2015
, p.
764153
.
16.
Shin
,
J. H.
, and
Park
,
A. W.
,
2010
, “
Updates on Percutaneous Radiologic Gastrostomy/Gastrojejunostomy and Jejunostomy
,”
Gut Liver
,
4
(
Suppl. 1
), pp.
S25
S31
.
17.
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
.
18.
Laasch
,
H. U.
, and
Martin
,
D. F.
,
2007
, “
Radiologic Gastrostomy
,”
Endoscopy
,
39
(
3
), pp.
247
255
.
19.
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
.
20.
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
.
21.
Dressman
,
J. B.
,
1986
, “
Comparison of Canine and Human Gastrointestinal Physiology
,”
Pharm. Res.
,
3
(
3
), pp.
123
131
.
22.
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
.
23.
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
24.
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
.
You do not currently have access to this content.