New Introducer Method for Percutaneous Gastrostomy in a Porcine Model
Bibliographic record
Abstract
Purpose: Percutaneous gastrostomies (PGs) may be placed endoscopically or fluoroscopically using T-bar fasteners to affix the stomach to the anterior abdominal wall. To prevent complications such as gastric perforation, infection, and GI bleeding, standard T-fasteners must be manually released following adequate adhesion formation. We examined the use of an innovative T-fastener and introducer kit that incorporates resorbable suture yielding easier initial deployment of T-bars fasteners allowing for automatic timed release of T-bars after PG placement. The objective was to determine the utility, convenience, and robustness of stoma development following PG tube placement in a porcine model using a novel T-fastener and introducer kit. Methods: 16 farm pigs underwent PG placement using the introducer kit. Three resorbable suture T-fasteners were placed in a triangular arrangement around a tentative abdominal stoma site and PG placed using the Russell method. Three differing visualization methods were used; endoscopic, laparoscopic and fluoroscopic. A second PG was placed endoscopically using the Ponsky pull method in each animal to serve as its own control. Ease of use and functionality of the new T-bar fastener and subsequent gross and histopathological integrity of gastropexy stoma formation was assessed over 1-3 weeks. Results: The test kit facilitated successful PG placement in all animals. Convenience scores were high and registered 70%-100% of the scoring range. There were no complications of PG placement using test or control devices. One study animal died immediately following the PG procedure due to anesthesia complications. At sacrifice, all PGs were intact with no evidence of infection, disruption or significant leakage. Probability analysis of retaining ≥1 or all 3 of the kit T-bar fastener devices was 94% and 38% at 1 week (n=5), 51% and 0% at 2 weeks (n=8) and 10% and 0 at 3 weeks (n=2), respectively. Histopathological indices of inflammation were similar with slight decreases in fibrosis in test compared to control sites (p=0.02, n=15). Stoma tracts of all test and control sites were robust and histologically mature at all time points. Stoma tract diameters were also similar between test and control PG's. (mean+sem: control 13.1+0.7mm, test 12.1+0.4mm: p=0.2, n=15). Conclusion: Placement and performance of PG using the new introducer method with novel low profile T-fasteners yields effective gastric anchoring and has similar ease of use as standard endoscopic PG placement. By incorporating resorbable T-fasteners, the new kit may have advantages by improving patient convenience while yielding similar histological healing to standard percutaneous gastrostomy procedures. Disclosure: John Fang - No financial relationship. James Carlisle - No financial relationship. Robert Glasgow - No financial relationship. Christopher Maxwell - No financial relationship. Kristen Hilden - No financial relationship. Jeremy Ollerenshaw - Employee. This research was supported by an industry grant from Kimberly Clark Health Care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".