Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Joshua Cornman-Homonoff

Abstract

PurposeTo compare the complication rate and time to the first reintervention of pull-type and push-type gastrostomy tubes placed under radiologic fluoroscopy guidance in adults. Materials and Methods During a 10-year period (2012-2022), 2341 adult patients underwent percutaneous radiological gastrostomy at our institution, and their charts were reviewed. 896 (39%) procedures were done with the push method, and 1393 (61%) were done with the pull method. Results Rates of significant hemorrhage at the surgical site, leakage at the site, and malplacement of the g-tube were not found to be statistically different between the two groups. However, push g-tubes were significantly more likely to be dislodged than pull g-tubes (Odds Ratio = 1.914, P < 0.001), and these patients were significantly more likely to require surgical re-intervention (Odds Ratio = 1.750, P < 0.001). Furthermore, push g-tube patients were significantly less likely to become infected at the surgical site (Odds Ratio = 0.555, P < 0.0159) and had much better 30-day survival (Odds Ratio = 2.157, P < 0.001) than pull g-tube patients. The predicted number of days to first re-intervention was significantly earlier (53 days) in the push group compared to the pull group (P < 0.008). Conclusions Push-type g-tube placements are associated with a higher rate of dislodgement and reintervention and have an earlier timeline to first reintervention in comparison with pull-type g-tube placements. On the other hand, patients with push placements had an increased 30-day survival rate than patients with pull placements.

Comments

This is an Open Access Thesis.

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