Ep. 252 How I Place Gastrostomy Tubes with Dr. Chris Beck

Ep. 252 How I Place Gastrostomy Tubes with Dr. Chris Beck

In this episode, Dr. Aaron Fritts interviews Dr. Christopher Beck about gastrostomy tubes, including the evolution of his method, tips for patients who pull their tubes out, and why g-tubes are such a controversial topic in IR. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/B9TbcW --- SHOW NOTES We begin by discussing indications and contraindications for gastrostomy tubes. Frequent indications are stroke patients, head and neck cancer patients, and trauma patients. Contraindications include uncorrectable coagulopathy, ascites, peritoneal carcinomatosis, or something interposed between the abdominal wall and the stomach, such as liver or bowel. Dr. Beck prefers having imaging to review, which most patients have. If no prior imaging is available, he will get a non-contrast CT abdomen the day of the procedure. He likes all his patients to drink barium for visualization of bowel during the procedure, but will not cancel the procedure if they didn’t drink it, as the insufflation should move bowel out of the way and there should be enough bowel gas to identify and avoid the bowel. Next, Dr. Beck reviews the details of his method. He likes to use monitored anesthesia care (MAC), because frequently he has patients with bad Mallampati scores. Additionally, anesthesia is very helpful with NG placement. Furthermore, it makes the procedure much more comfortable for the patient. He always checks liver margins with ultrasound prior to starting the procedure. He always gives 1 mg glucagon before insufflation and antibiotics per the SIR Guidelines App. As for equipment, he uses t-fasteners from Avanos, a dilator set, and a 20Fr G-tube. He used to start with 16Fr but found he frequently had to size up to a 20Fr. He uses a 24Fr peel away sheath. For the procedure, he insufflates, marks his entry point with a hemostat, and then numbs in all 3 spots where he will place his gastropexies. He uses 1/2 syringe of contrast for his gastropexy placement. He uses 2 t-tags, and prefers the C-arm in RAO rather than AP during this step. For G-tube placement, he aims 20 degrees toward the pylorus, and always makes sure he sees wire touching two walls of the stomach to ensure he is intraluminal. He uses sterile water to inflate the balloon rather than saline or contrast. Lastly, he always makes sure to get a good final image to confirm placement in the stomach. For post-care, on inpatients he rounds the next morning, checking that the tube flushes and then clears it for use. For outpatients, he recommends no feeding (via G or NG) for three hours and a consult with a dietician before discharge. After this, the patient can receive nutrition via NG. If the patient has no peritoneal signs, the G-tube can be used the next day. For tube management, he exchanges the tube every 6 months or sooner if there is an issue, such as the tube being pulled out or becoming clogged beyond the point of a bedside fix. --- RESOURCES BackTable YouTube Gastrostomy Tube Demo: https://www.youtube.com/watch?v=17ep0AEkKqs Early Initiation of Enteral Feeding: https://pubmed.ncbi.nlm.nih.gov/24674218/ SIR Guidelines App: https://apps.apple.com/us/app/sir-guidelines/id1552455529

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Ep. 614 Interventional Radiology’s Evolution: Insights from Dr. Ernest Ring

Ep. 614 Interventional Radiology’s Evolution: Insights from Dr. Ernest Ring

Have you ever wondered what it was like to be in the room when the first pelvic embolization was performed or how the TIPS procedure was pioneered? Dr. Ernie Ring, a legendary figure from UCSF and a t...

6 Helmi 50min

Ep. 613 Microwave Ablation in Renal Tumors with Dr. Steven Huang

Ep. 613 Microwave Ablation in Renal Tumors with Dr. Steven Huang

You’re about to biopsy a renal lesion; should you ablate at the same time? In this episode of the BackTable Podcast, host Michael Barraza talks with Dr. Steven Huang from MD Anderson Cancer Center abo...

3 Helmi 49min

Ep. 612 Interventional Radiology in Military Medicine with Dr. John York

Ep. 612 Interventional Radiology in Military Medicine with Dr. John York

What does day-to-day interventional radiology look like in the military? Here’s a firsthand account. Dr. John York, interventional radiologist at University of California San Diego with 37 years of ac...

30 Tammi 50min

Ep. 611 Challenges in Prostate Artery Embolization with Dr. Rajasekhara Ayyagari

Ep. 611 Challenges in Prostate Artery Embolization with Dr. Rajasekhara Ayyagari

Are balloon occlusion microcatheters your new best friend for prostate artery embolization (PAE)? In this episode of BackTable, Dr. Raj Ayyagari, interventional radiologist at Boston Medical Center, ...

27 Tammi 46min

Ep. 610 Interventional Radiology in UAE: Current Practices with Dr. Jamal Alkoteesh

Ep. 610 Interventional Radiology in UAE: Current Practices with Dr. Jamal Alkoteesh

Have you ever considered taking a sabbatical to practice Interventional Radiology in the Middle East? In this episode, Dr. Jamal AlKoteesh, the Chairman of Clinical Imaging at SEHA and the "Godfather ...

23 Tammi 35min

Ep. 609 Chronic Venous Disease Diagnosis & Management Strategies with Dr. Steven Abramowitz

Ep. 609 Chronic Venous Disease Diagnosis & Management Strategies with Dr. Steven Abramowitz

20 Tammi 50min

Ep. 608 Interventional Radiology Global Survey: Training & Awareness with Dr. Justin Guan and Dr. Constantinos Sofocleous

Ep. 608 Interventional Radiology Global Survey: Training & Awareness with Dr. Justin Guan and Dr. Constantinos Sofocleous

Patient access to interventional radiology services remains highly variable worldwide, reflecting global differences in training opportunities and infrastructure. Drawing on responses from more than 1...

16 Tammi 38min

Ep. 607 Interventional Radiology Coding & Compliance Essentials with Dr. David Zielske

Ep. 607 Interventional Radiology Coding & Compliance Essentials with Dr. David Zielske

Are you getting paid for the work you do? In this episode of the BackTable Podcast, interventional radiology coding expert Dr. David Zielske joins host Dr. Ally Baheti to share practical tips for bill...

13 Tammi 1h 5min

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