Purpose or Case Report: Gastrostomy tube (GT) or gastrojejunostomy tube (GJT) checks are a frequently ordered radiographic procedure to confirm placement. The goal of this study was to evaluate the accuracy of after-hours examinations for GJ or GJT placement using abdominal radiographs after injection of contrast, as compared to traditional fluoroscopy exams, which utilize a radiologist to perform the procedure.

Methods & Materials: We performed a retrospective cohort study including all subjects who underwent a GJ or GJT tube checks utilizing fluoroscopy and after-hours protocols between 1/1/2008 and 1/1/2019 at a single tertiary pediatric center. After-hours examinations were defined as checks that consisted of frontal and lateral abdominal radiographs after injection of contrast through the indwelling GT or GJT, regardless of time performed. Fluoroscopy exams were defined as exams which were performed in the fluoroscopy suite supervised by a radiologist. Radiology reports were evaluated for complications, such as malposition or extravasation. Clinical notes from the day of the procedure and longer term clinical follow up notes were used as a gold standard for complications. Sensitivity and specificity of the two procedures was calculated and a Fisher’s exact test was used to compare the two procedures.

Results: A total of 147 (n=68 (46%) fluoroscopy, n=79 (54%) after hours technique) studies were evaluated. Long term clinical notes from a median of 37 days were used as part of the gold standard (range: 1-176 days). Clinically, seventeen exams (12%) demonstrated either malposition or serious complication. Radiologically, eight exams (12%) were abnormal by fluoroscopy and five exams (6%) by after-hours technique. There were five (3%) false negative examinations, where complication or malposition was discovered on follow up clinical evaluation. Of these, four were by fluoroscopic evaluation. Fluoroscopy exams had a sensitivity of 67% and specificity of 100% for tube position and after-hours exams had a sensitivity of 80% and specificity of 99% for tube position. Using a Fisher’s exact test, the sensitivity and specificity are equivalent for these two types of exams.

Conclusions: This study concludes that fluoroscopy and after-hours techniques have no significant difference in detecting tube complications.