G-tube contrast check: Transition from fluoroscopy to abdominal radiographs

Reports of radiographic exam evaluation for G-tube malposition in children are limited.

Evaluate effectiveness of a new 2-view abdominal radiograph exam protocol instituted to provide 24/7 coverage at 2 affiliated hospitals and replace the prior fluoroscopic G-tube contrast check exam.

G-tube radiographic exams performed between December 2019 and May 2022 at 2 affiliated hospitals were identified and retrospective chart review was performed to delineate exam test yield, accuracy, sensitivity, specificity. Additional data collected included exam adherence to protocol, years of experience of the reporting pediatric radiologist, reporting time, and 30-day adverse events.

227 exams were performed in 186 patients. 2-view radiograph protocol was followed in 81.9% (186/227); Additional radiograph views were performed in 18.1% (41/227); additional contrast volume in 9.3% (21/227). Reporting time under 1 hour occurred in 79.7% (181/227). 5.7% (13/227) exams were reported as indeterminate adding a median time delay of 40 minutes (IQR 90). Indeterminate exam reporting did not correlate with years of experience of the reporting pediatric radiologist (p=0.19); reporting time over 1 hour occurred more often in the after-hours group (p= 0.032). Fluoroscopic G-tube contrast check was requested in 8 of 13 indeterminate readings. Following reclassification of indeterminate exams based on clinical suspicion, test performance: yield 94.3%, accuracy 97.3%, sensitivity 81.8%, specificity 98.2%, PPV 69.2%, NPV 99.1%.

This new diagnostic exam performed well with high test yield, accuracy, specificity and negative predictive value. The exam mostly followed protocol, allowed timely resumption of G-tube use, and provided a needed 24/7 remote coverage option for the new affiliated hospital.