Abstract
Objective This study aims to assess the regional variation and overall longitudinal prevalence
of approaches to gastrostomy tube placement in patients covered by Medicare or Medicaid.
Background Gastrostomy tubes are most commonly inserted endoscopically given the approaches’
demonstrated safety, success, and patient outcomes as compared with laparoscopic approaches.
Recently, the growth of interventional radiology services has provided patients with
an alternative percutaneous approach. The safety and efficacy of this approach as
opposed to endoscopic approaches has yet to be determined.
Methods From 2005 to 2014, Medicare Standard Analytic Files derived from Medicare parts A
and B, which contain 100% of inpatient and outpatient facility records billed to Medicare,
were retrospectively analyzed. Age, sex, year of placement, region, comparative quarterly
ratio, regional cost variation, and overall financial cost were compared between both
cohorts.
Results Our population included a total of 336,021 patients; of those, 30,327 patients underwent
fluoroscopic guided procedures, and 305,694 patients underwent endoscopic procedures.
Age (p < 0.001), region (p = 0.043), and year of placement (p < 0.001) varied significantly between these populations. Fluoroscopic-guided procedures
were found to have a statistically significantly lower average cost of treatment compared
with endoscopic gastrostomies ($2,018.62 vs. $2,471.33, respectively, p = 0.03).
Conclusion This study demonstrates an increasing prevalence of fluoroscopically placed gastrostomy
tubes as compared with those placed endoscopically.
Keywords
gastrostomy - G-tube - percutaneous endoscopic gastrostomy - endoscopic - fluoroscopic
