Scientists at the Lawson Health Research Institute, the research arm of London’s hospitals, are completing a clinical trial that eliminates the need for specialized imaging suites to place feeding tubes – a potentially game-changing development that can reduce cost and wait times.
Feeding tubes help provide nutrition to patients who are unable to eat. Some of these patients have head and neck cancers and others are unable to swallow because of stroke or trauma.
The regular process to insert a feeding tube involves sedating the patient, moving them to an imaging suite and using X-ray or endoscopy camera equipment to place the device in the stomach. Operating the specialized medical suites comes with a high cost and can also come with lengthy wait times, interventional radiologist and associate Lawson scientist Derek Cool said.
The new PUMA-G method uses a liquid-filled balloon, a magnet, two guide wires and ultrasound to place the feeding tube.
The patient is sedatedand the balloon-magnet device is fed on a wire through the patient’s mouth. A magnet on the patient’s skin positions the balloon against the wall of the stomach. Doctors inflate the balloon with liquid so it shows up on the ultrasound and puncture it with a hollow needle inserted through the patient’s abdomen. They then feed a second guide wire through the needle and, using the first guide wire, pull the deflated balloon out through the patient’s mouth, while also dragging second guide wire up. The feeding tube is then attached to the second guide wire and pulleddown the patient’s throat and into position.
“We don’t have to use expensive X-ray equipment,” Cool said. “Generally, the cases have all gone well. We haven’t had any major complications related to the procedure. . . . I’m interested in seeing how we can adopt the technology here.”
Cool said the new method could be especially beneficial for medically fragile patients.
“What drew me to it, in particular, was the ability to do the procedure outside our suites,” Cool said. “Patients who need feeding tubes, some of them are really sick and in the intensive care unit. This procedure can actually be done at their bedside. We’ve actually done three patients that were in the ICU. . . . They don’t have to be transported to our department.”
The London Health Sciences Centre team first used the new procedure on a patient in October 2018 and has since placed feeding tubes in 18 patients using the PUMA-G device. They’re seeking another seven to bring the clinical trial to 25 patients.
The research team has already submitted a paper to the Journal of Vascular and Interventional Radiology on the first five patients who underwent the new procedure, Cool said.
Sarnia resident Sonny McGlone was the first human patient in the world to have a feeding tube inserted using the PUMA-G method. He was undergoing radiation for head and neck cancer and was not able to swallow or eat.
“I didn’t realize at the time I was the first patient. They did say at the time it was a new procedure,” said McGlone, who is now cancer-free. “It went very well. It was life-saving for me. My throat was aching from the radiation. I couldn’t eat. . . . The tube worked well for me.”
The device is made by Baltimore-based medical company CoapTech. The company’s co-founder and chief medical officer Dr. Steven Tropello got the idea after seeing a patient in the emergency room who had pulled out their feeding tube.
The patient had to be admitted to the hospital. It took a couple days for an imaging suite to become available so the patient could get the feeding tube put back in.
“Everybody lost in that picture,” said CoapTech co-founder and chief executive Howard Carolan. “The patient lost because they had to spend days of their life in a hospital. . . . The hospital lost because the patient was taking up a hospital bed with a patient that could have been in and out the door if Dr. Tropello had the tools to deal with it on the front lines.”
CoapTech connected with London Health Sciences Centre when Cool stopped by their booth at the medical conference.
CoapTech is encouraged by how the PUMA-G device has worked in patients and is grateful for the team of London researchers who have led the charge.
“It was a really good feeling when we connected with the team at LHSC. There was a lot of good camaraderie in the aim of doing something new that could benefit patients we all care about,” Carolan said. “The team has been hard at work helping to refine and optimize this new method. . . . They’ve done so much good work.”