Gastrostomy tube check radiographs: performance of an alternative diagnostic exam

The traditional imaging exam to check a gastrostomy tube (G-tube) used fluoroscopy, which requires the presence of a radiologist. Evaluate the effectiveness of an alternative 2-view abdominal radiograph exam protocol instituted to replace the prior fluoroscopic G-tube contrast check exam and provide 24/7 coverage at 2 affiliated hospitals.

An alternative 2-view G-tube check radiograph exam following stratified contrast administration was introduced at 2 affiliated children's hospitals. Gastrostomy-tube radiograph exams performed between December 2019 and May 2022 at 2 affiliated hospitals were identified, and a retrospective chart review was performed to delineate exam test yield, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Additional data collected included exam adherence to the protocol, 30-day adverse events, reporting time, and the years of experience of the reporting pediatric radiologist.

A total of 227 exams were performed among 186 patients. The 2-view radiograph protocol was followed in 81.9% (186/227). Additional radiograph views were performed for 18.1% (41/227) of cases, and additional contrast volume for 9.3% (21/227) of cases. A fluoroscopic G-tube contrast check was requested for 7 of 13 indeterminate readings with high clinical suspicion. Following the reclassification of indeterminate exams based on clinical suspicion, exam performance results were as follows: test yield, 94.3%; accuracy, 97.8%; sensitivity, 90.0%; specificity, 98.2%; PPV, 69.2%; NPV, 99.5%. The 1 false negative exam required a second hospital visit 7 days after the initial exam to detect and correct G-tube malposition. Reporting time under 1 hour occurred in 79.7% (181/227). Delayed radiology reporting in 1 patient led to endoscopic confirmation of abnormal G-tube alignment. Furthermore, 5.7% (13/227) exams were reported as indeterminate, adding a median time delay of 40 minutes (interquartile range, 90). Indeterminate exam reporting did not correlate with the years of experience of the reporting pediatric radiologist (P = 0.189). Reporting time over 1 hour occurred more often in the after-hours group (P = 0.032).

This alternative diagnostic exam performed well in terms of high test yield, accuracy, sensitivity, specificity, and NPV. The exam mostly followed protocol, allowed for the timely and safe resumption of G-tube use, and provided the remote coverage needed for a new satellite hospital.

This diagnostic radiograph exam replaced the on-site fluoroscopic exam as the initial imaging exam for G-tube checking in our pediatric population.