London team first in the world to test new way of inserting feeding tubes

Spring 2020

Sonny McGlone was undergoing treatment for head and neck cancer when a feeding tube became necessary. In October 2018, he was the first patient in the world to have his feeding tube inserted using a novel procedure at LHSC’s Victoria Hospital.

“I had seven weeks of radiation which killed my taste buds. I couldn’t swallow or eat, and I was rapidly losing weight,” explains Sonny, a 76-year-old man from Sarnia, Ontario. “I was pleasantly surprised by the feeding tube procedure. While the tube was obviously inconvenient, it was a life-saver.”

The procedure was performed as part of a study at Lawson Health Research Institute, the research institute of LHSC and St. Joseph’s Health Care London. In partnership with medical device company CoapTech LLC, a team of researchers is assessing the safety of a new device called the PUMA-G System.

The device is used to perform the new method of gastronomy feeding tube insertion and will be studied with 25 patients at LHSC. The procedure could offer improved patient safety while providing cost savings to the health-care system.

Feeding tubes are needed by those who cannot maintain adequate nutrition through the mouth. Each year, approximately 400 patients at LHSC require a gastronomy feeding tube. They can be very important to the treatment of and recovery from conditions like cancer, stroke and trauma.

Normally, the insertion of a feeding tube is guided by x-ray imaging or endoscopy, a procedure that uses a camera and light to visualize the stomach. While highly effective, these methods require use of specialized imaging suites that are critically needed by many patients. The time and resources required in these suites can also be costly to the health-care system.

The PUMA-G System provides a new method of gastronomy feeding tube insertion that can be performed at a patient’s bedside. The device uses a magnetic balloon that is fed through a patient’s mouth and guided to the stomach with an external magnet. The balloon is inflated with water and ultrasound guides the treating physician as they insert a needle through the stomach and into the balloon. The balloon catches a wire that is then pulled back up and out the mouth as the balloon is removed. A feeding tube can be pushed back down over the wire and safely out the stomach.

“This new method is already showing promise as being safe, effective and efficient. It allows feeding tubes to be inserted at the patient’s bedside and reduces the demand on specialized imaging suites,” says Dr. Derek Cool, Associate Scientist at Lawson and Interventional Radiologist at LHSC. “This could be especially important for patients in the intensive care unit (ICU). They can benefit from the safety of that environment without being moved.”

The PUMA-G System also minimizes the risk of puncturing other organs. Traditional methods do not show the space between the skin and stomach. While rare, there’s a small risk that organs like the liver or colon could be injured during insertion. Ultrasound minimizes this risk by allowing physicians to see between the skin and stomach while the needle is being inserted.

The device has potential to provide visualization for procedures in other hollow organs too, such as the small intestines and bladder.

Lawson Health Research Institute is the research institute of London Health Sciences Centre and St. Joseph’s Health Care London. Learn more about our research at www.lawsonresearch.ca.

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Dr. Derek Cool demonstrates the PUMA-G System, a device used to perform a new method of gastrostomy feeding tube insertion. The procedure is being studied with 25 patients at LHSC and could offered improved patient safety.