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Chick JFB, Jairath N, Bundy JJ, Adapa A, Shields JJ, Hage AN, Srinivasa RN. The occlusion balloon reduction technique for de novo placement and salvage of malpositioned enteric tubes. Abdom Radiol (NY) 2019; 44:2916-2920. [PMID: 31065744 DOI: 10.1007/s00261-019-02029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Nasoenteric, gastrojejunostomy, and jejunostomy tubes are methods of enteral nutrition in patients with functioning gastrointestinal tracts who cannot maintain adequate oral intake. Current placements; however, may be complicated by redundant wire and catheter loops within the stomach preventing operators from optimal feeding tube placement and predisposing patients to feeding tube prolapse. This report describes the occlusion balloon reduction technique for salvage of malpositioned tubes and placement of new enteric tubes in the setting of redundant loops. MATERIALS AND METHODS Five patients underwent the occlusion balloon reduction technique for jejunostomy (n = 3), gastrojejunostomy (n = 1), or nasojejunal tube placement (n = 1). All patients (n = 5) had redundant wires coiled within the stomach. In all patients (n = 5), a 9-French × 32 mm × 120 cm Coda balloon was inserted over the wire and passed into the small bowel. The balloon was inflated after which reduction of redundancy in the upper gastrointestinal tract was performed. Feeding tubes were then placed with tips in the distal jejunum. Technical success of the occlusion balloon reduction technique, successful placement of enteric tube, complications, and follow-up were recorded. RESULTS The occlusion balloon reduction was technically successful in all patients (n = 5). Feeding tube placement was successful in all patients (n = 5). No minor or major complication occurred. Mean follow-up was 56 days. CONCLUSION The occlusion balloon reduction technique provides a method for reduction of redundant wire and catheter loops within the stomach during enteric tube placement or repositioning.
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Affiliation(s)
- Jeffrey Forris Beecham Chick
- Cardiovascular and Interventional Radiology, INOVA Alexandria Hospital, 4320 Seminary Road, Alexandria, VA, 22304, USA.
| | - Neil Jairath
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jacob J Bundy
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Arjun Adapa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - James J Shields
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anthony N Hage
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ravi N Srinivasa
- Division of Interventional Radiology, Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
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Chick JFB, Jairath N, Gemmete JJ, Hage AN, Bundy JJ, Patel NA, Johnson EJ, Khayat M, Srinivasa RN. Transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias. Abdom Radiol (NY) 2019; 44:1894-1900. [PMID: 30756147 DOI: 10.1007/s00261-019-01905-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias. MATERIALS AND METHODS Four patients, including three (75%) females and one (25%) male, with mean age of 77.5 years (range 73-78 years), and with a hiatal hernia and intrathoracic stomach precluding gastrostomy placement and loop snare placement into the mid-jejunum underwent the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement. In all patients, a duodenal stent was inserted into the jejunum in a transnasal fashion. The stent was partially unsheathed in an anterior loop of jejunum and percutaneously targeted using an 18-gauge needle through which a guidewire was advanced, trapped within the stent, and removed through the nose. The tract was serially dilated and a jejunostomy was placed. Technical success, procedure time, fluoroscopy time, radiation exposure, complications, time to enteral feeding, and follow-up were recorded. RESULTS Technical success was 100% (4/4) with all four patients requiring only one needle pass before successful jejunal cannulation. Mean procedure time was 108 min. Mean fluoroscopy time was 44 min. Mean dose area product was 3969.3 μGym2. No minor or major complications occurred. All four patients received enteral feeding one day after the procedure. Mean follow-up was 366 days. CONCLUSION The transnasal stent-assisted targeting technique is a novel method for primary jejunostomy placement in patients with hiatal hernias.
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Affiliation(s)
- Jeffrey Forris Beecham Chick
- Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA, 22304, USA.
| | - Neil Jairath
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Joseph J Gemmete
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anthony N Hage
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jacob J Bundy
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Nishant A Patel
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Evan J Johnson
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mamdouh Khayat
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ravi N Srinivasa
- Division of Interventional Radiology, Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
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Srinivasa RN, Sherk WM, Chick JFB, Cooper K, Gemmete JJ. Transgastric jejunal snare technique facilitates primary jejunostomy placement. Radiol Case Rep 2018; 13:150-152. [PMID: 29552254 PMCID: PMC5851276 DOI: 10.1016/j.radcr.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/07/2017] [Accepted: 10/08/2017] [Indexed: 10/26/2022] Open
Abstract
Placement of percutaneous jejunostomy tubes using fluoroscopy may be technically challenging because of the peristaltic motion of small bowel loops within the peritoneum. Furthermore, fluoroscopic jejunostomy placement has an inherent risk of complications, including peritonitis and death. A transnasal snare technique to facilitate direct jejunostomy in patients with a surgically altered gastric anatomy has been previously reported. This report describes a patient with gastroparesis and a chronic nasojejunal tube who underwent a percutaneous transgastric snare technique to facilitate the placement of a direct jejunostomy.
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Affiliation(s)
- Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI 48109
| | - William M Sherk
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI 48109
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI 48109
| | - Kyle Cooper
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI 48109
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI 48109
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