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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024:10.1007/s00261-024-04381-x. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Lim JS, Jung GS, Oh KS, Seo KW, Jung K, Yun JH. Percutaneous radiologic gastrostomy with single gastropexy using balloon-assisted tract dilatation: comparison with peel-away sheath. Diagn Interv Radiol 2023; 29:813-818. [PMID: 37650523 PMCID: PMC10679556 DOI: 10.4274/dir.2023.232342] [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] [Received: 06/05/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous radiologic gastrostomy (PRG) with balloon-assisted tract dilatation (BATD) using a single gastropexy. METHODS This retrospective study was approved by the institutional review board. From August 2018 to October 2022, 61 patients (53 male and 8 female, mean age 67 years, age range 27-90 years) underwent PRG with balloon-retained tubes for enteral nutrition. Single gastropexy was performed in all cases. Patients were divided into two groups based on the tract dilatation technique used. In the first group, BATD (n = 48) was performed. In the second group, a 24-Fr peel-away sheath (PAS) was used for tract dilatation (n = 13). Patient demographics, technical success rate, clinical success rate, fluoroscopy time, cumulative radiation dose, and complications were retrospectively evaluated. The Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables were performed to compare the two groups. RESULTS All procedures were successfully performed with 100% technical and clinical success rates in both groups. The mean fluoroscopy time for the BATD group vs. the PAS group (1.68 ± 0.93 min vs. 3.56 ± 2.41 min, P < 0.001) and mean cumulative radiation dose (12.98 ± 9.28 mGy vs. 33.01 ± 15.14 mGy, P < 0.001) were significantly lower in the BATD group compared with the PAS group. There was one major complication of peritonitis that led to death in the PAS group (1/13, 7.7%) and no major complications in the BATD group. Minor complications such as pneumoperitoneum, abdominal pain, leakage, and balloon deflation occurred in 16 patients: 12 (12/48, 25.0%) patients in the BATD group and 4 (4/13, 38.5%) patients in the PAS group. The overall rate of major and minor complications was higher in the PAS group but did not show statistically significant differences (odds ratio: 1.875, 95%; confidence interval: 0.514-6.841, P = 0.486). CONCLUSION BATD using a single gastropexy is a safe and effective technique for PRG.
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Affiliation(s)
- Ji Su Lim
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
| | - Gyoo Sik Jung
- Department of Radiology, Ulsan Hospital, Ulsan, Korea
| | - Kyung Seung Oh
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jong Hyouk Yun
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
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Lee S, Ghosh A, Raymond A, Akhter NM. A comparison of balloon-assisted versus dilator in percutaneous gastrostomy tube placement. J Clin Imaging Sci 2023; 13:25. [PMID: 37810182 PMCID: PMC10559364 DOI: 10.25259/jcis_55_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives This study assesses the safety and efficacy of balloon-assisted gastrostomy (BAG) compared to conventional techniques using dilators. Material and Methods A single-center retrospective review of all fluoroscopically-guided percutaneous gastrostomy tube insertions from July 2017 to September 2020 was performed. Two hundred and seventy-three patients were included in this study, with 183 patients and 90 patients in the BAG and dilator groups, respectively. Fluoroscopy time, peak radiation dose, pain management, days to interventional radiology (IR) reconsultation, and post-operative complications (major and minor) for each procedure were reviewed to evaluate for statistical differences. Results There were shorter fluoroscopy times (5.13 min vs. 7.05 min, P = 0.059) and a significantly lower radiation use (Avg = 102.13 mGy vs. 146.98 mGy, P < 0.05) in the BAG group. The BAG group required significantly lower operating time (41 min vs. 48 min, P < 0.01) and received lower pain management (fentanyl 75 mcg and midazolam 1.5 mg, P < 0.001). The mean days to IR reconsultation for the BAG group was greater (29 days vs. 26 days, P = 0.38). The overall rate of minor complications (grades 1 and 2, according to the CIRSE classification system) was higher in the dilator group (39% vs. 35% in BAG group, P = 0.53). No major complications were reported in either group. Conclusion BAG is a safe and efficient technique for percutaneous gastrostomy tube placement. BAG patients required significantly lesser radiation, OR time, post-operative pain management, and recorded lower postoperative complications compared to their counterparts in gastrostomies utilizing dilators.
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Affiliation(s)
- Sean Lee
- Department of Diagnostic Radiology, Touro College, Middletown, New York, United States
| | - Abheek Ghosh
- Department of Interventional Radiology, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Aislynn Raymond
- Department of Interventional Radiology, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Nabeel M. Akhter
- Department of Radiology and Nuclear Medicine, Mercy Medical Center, Baltimore, Maryland, United States
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Dams G, Knapen RRMM, Korenblik R, van Dam RM, de Haan MW, van der Leij C. 12Fr-Pigtail Versus 14Fr-Balloon Percutaneous Radiologic Gastrostomy (PRG), Retrospective Evaluation of Outcomes and Complications; A Maastricht University Medical Centre Study. Cardiovasc Intervent Radiol 2023; 46:1231-1237. [PMID: 37592019 PMCID: PMC10471621 DOI: 10.1007/s00270-023-03527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To retrospectively compare tube and placement related results of a 12Fr-pigtail and a 14Fr-balloon gastrostomy tube. MATERIALS AND METHODS All consecutive patients who underwent percutaneous radiologic gastrostomy (PRG) between January 2016 and June 2020 were enrolled in this retrospective single-center analysis. Follow-up for all patients was 180 days. Mortality after 30 days, technical success, days to first complication within 180 days, reason of unexpected visit (tube, anchor or pain related), and tube specific complications (obstruction, pain, luxation, leakage) were taken as outcome measures. Data were obtained from both PACS software and electronic health records. RESULTS A total of 247 patients were enrolled (12Fr-pigtail: n = 139 patients and 14Fr-balloon: n = 108 patients). 30-day mortality was very low in both groups and never procedure related. Technical success was 99% in both groups. The average number of complications within 180 days after initial PRG placement was significantly higher in the 12Fr-pigtail group (12Fr-pigtail: 0.93 vs. 14Fr-balloon: 0.64, p = 0.028). Time to first complication within 180 days was significantly longer in the 14Fr-balloon group (12Fr-pigtail: 29 days vs. 14Fr-balloon: 53 days, p = 0.005). In the 14Fr-balloon group, the rate of tube-related complications (luxation and obstruction) was significantly lower compared to 12Fr-pigtail (29% vs. 45%, p = 0.011). CONCLUSION 14Fr-balloon gastrostomy tubes have significantly lower (tube-related) complications rates and longer time to first complication compared to 12Fr-pigtail tubes. No procedure-related mortality was observed in either group. Technical success was very high in both groups. Level of Evidence Level 3, non-controlled retrospective cohort study.
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Affiliation(s)
- Glenn Dams
- Department of Radiology and Nuclear Medicine, Zuyderland MC, Sittard-Geleen, Netherlands
| | - Robrecht R M M Knapen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.
- CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.
| | - Remon Korenblik
- Department of Surgery, Zuyderland MC, Sittard-Geleen, Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Ronald M van Dam
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - Michiel W de Haan
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Christiaan van der Leij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
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Cone-beam computed tomography-assisted percutaneous gastrostomy tube insertion in children with challenging anatomy. Pediatr Radiol 2023; 53:963-970. [PMID: 36720724 DOI: 10.1007/s00247-023-05593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/11/2022] [Accepted: 01/10/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Percutaneous radiological gastrostomy tube insertion is a common procedure in children. An approach using ultrasound and fluoroscopy may not be feasible in patients with challenging anatomy; therefore, advanced techniques or other imaging modalities may be required. OBJECTIVE To describe our experience using cone-beam computed tomography (CT)-assisted percutaneous gastrostomy insertion in pediatric patients with challenging anatomy. MATERIALS AND METHODS A retrospective review was performed in children who underwent cone-beam CT-assisted percutaneous radiologic gastrostomy between January 2015 and July 2019. Indications, technique, outcomes, complications, and radiation dose (reference-point air kerma, air kerma area product) were assessed through chart and imaging review. Descriptive statistics only were used. RESULTS Twenty-seven procedures were attempted in 26 patients. Reasons for utilizing cone-beam CT guidance were high-positioned stomach (n = 10), interposing bowel loops and liver (n = 19), omphalocele (n = 1), severe scoliosis (n = 1), and ventriculoperitoneal shunt (n = 1). Technical success was 85% (23/27). Mean procedure time was 96 min (range 50-131 min). No safe access route into the stomach was encountered in four patients; three were referred for surgical gastrostomy and one had a successful re-attempt. Radiation dose data was obtained from 19 procedures (17 successful) with a total dose in successful procedures ranging from 8.1 to 63.6 mGy (average 26.2 mGy, median 24.9 mGy). The number of cone-beam CT acquisitions per procedure ranged from 1 to 4. Major complication frequency was 11% (3/27) (bleeding, peritonitis, and aspiration pneumonia); minor complication frequency was 3.7% (1/27). CONCLUSION This study shows that cone-beam CT guidance can be useful for assisting percutaneous radiologic gastrostomy in children with challenging anatomy.
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Maroun G, Pugash R, Meirovich H, David E. Efficiency and Safety of Balloon-Assisted Gastrostomy. Cardiovasc Intervent Radiol 2021; 44:1423-1429. [PMID: 34231010 DOI: 10.1007/s00270-021-02865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the safety and efficiency of balloon-assisted gastrostomy for insertion of large bore feeding tubes compared to conventional techniques using dilators. MATERIALS AND METHODS Retrospective review of all fluoroscopically guided percutaneous gastrostomy tube insertions between July 2017 and September 2019 was performed. Collected data points included patient demographics, initial pathology, type of gastrostomy tube (G tube) inserted [(Avanos standard balloon retained (Mic-G), or low-profile balloon retained (Mic-Key)], type of insertion technique (balloon-assisted or -nested dilator technique), fluoroscopy time, amount of sedation required, technical success, and complications. The focus of the study was method of tract dilatation - either balloon-assisted gastrostomy (BAG group) versus nested or sequential dilators (dilator group). Two hundred patients were included in this study; 100 patients were evaluated in each group. RESULTS There were no significant differences between the two groups. The overall rate of minor complications (grades 1 and 2, according to the CIRSE classification system) was higher in the dilator group (11%, compared to 7% in the BAG group) but did not reach statistical significance. Males were associated with lower risk of minor complications (OR 0.19, 95% CI (0.07, 0.53)), while age did not present a significant association. Patients in the BAG group received a significantly lower amount of fentanyl (p < 0.001) and midazolam (p < 0.001) than patients in the dilator group. CONCLUSION Balloon-assisted gastrostomy is a safe and effective technique for large bore gastrostomy placement. Patients required less sedation, allowing for faster recovery and discharge time in outpatients at our institution.
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Affiliation(s)
- Gilbert Maroun
- Vascular/Interventional Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Robyn Pugash
- Vascular/Interventional Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Harley Meirovich
- Vascular/Interventional Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Elizabeth David
- Vascular/Interventional Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada.
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Partovi S, Li X, Moon E, Thompson D. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26:383-392. [PMID: 32063687 PMCID: PMC7002903 DOI: 10.3748/wjg.v26.i4.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube is an effective and safe long-term feeding access that is well-tolerated by patients. The typical placement routes include surgical, endoscopic and interventional radiologic placement. In particular, percutaneous interventional radiologic gastrostomy (PIRG) has increasingly become the preferred method of choice in many practices. Although many PIRG techniques have been developed since the 1980s, there is still a paucity of evidence supporting the choice of a most-optimal PIRG technique. Hence, there is a large variation in institutional approach to PIRG. We are a large, quaternary academic institution with an extensive experience in PIRG. Therefore, we aim to present the “push” PIRG technique utilized in our institution, to review the current literature, to discuss the optimal choice of PIRG technique and to generate further interests in comparison studies.
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Affiliation(s)
- Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Eunice Moon
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Dustin Thompson
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
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Retrospective comparison of outcomes and associated complications between large bore radiologically inserted gastrostomy tube types. Abdom Radiol (NY) 2019; 44:318-326. [PMID: 30073401 DOI: 10.1007/s00261-018-1717-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Multiple approaches to radiologically inserted gastrostomy (RIG) exist. The goal of this study was to compare 30-day outcomes and associated complications between large bore balloon-retained (BR), loop-retained (LR), and pull-type (PT) RIG devices. METHODS Data on 1477 patients who underwent RIG between January 1, 2005 and December 31, 2016 were collected retrospectively using a dedicated interventional radiology database and electronic medical record. Statistical analysis was performed to compare complication rates between BR, LR, and PT devices. RESULTS Ninety-eight percent (1477/1507) of the procedures were successfully performed. A total of 752 BR, 323 LR, and 402 PT gastrostomy tubes were placed. The overall complication rate for BR catheters was 5.7% (25 major [3.3%] and 18 minor [2.4%]). The overall complication rate for PT catheters was 3.7% (8 major [2.0%] and 7 minor [1.7%]). The overall complication rate for LR catheters was 1.6% (4 major [1.4%] and 1 minor [0.8%]). Compared to BR catheters, LR catheters had significantly fewer total complications (P = 0.01) but not minor complications (P = 0.052). There were no significant differences in the number of complications between LR and PT catheters or between BR and PT catheters. CONCLUSIONS Use of BR, LR, and PT devices for RIG is safe with a low incidence of complications. Compared to BR catheters, primary insertion of a LR gastrostomy was associated with significantly fewer overall complications within the first 30 days. Therefore, for initial tube placement, large bore LR catheters may be preferred over BR devices.
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Han K, Kim MD, Kwon JH, Kim YS, Kim GM, Lee J, Choi W, Won JY, Lee DY. Randomized Controlled Trial Comparing Radiologic Pigtail-Retained Gastrostomy and Radiologic Mushroom-Retained Gastrostomy. J Vasc Interv Radiol 2017; 28:1702-1707. [PMID: 28802552 DOI: 10.1016/j.jvir.2017.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To prospectively compare 2 different types of percutaneous fluoroscopic gastrostomy procedures (pigtail-retained gastrostomy [PG] vs mushroom-retained gastrostomy [MG]). MATERIALS AND METHODS Between March 2014 and February 2016, 100 patients were randomly assigned to receive 14-F PG or 20-F MG. Block randomization (block size 4) was performed, and sample size was calculated to assess the difference in minor complications. One patient withdrew from the study after allocation. Baseline characteristics were not significantly different between groups (P > .05). Technical success, defined as successful placement of gastrostomy tube, and procedural complications were evaluated. Procedural complications were divided into major and minor complications according to the Society of Interventional Radiology criteria. RESULTS Technical success rate was 100%. In the PG group, the major complication rate was 2% (1 of 50); 1 patient had a misplaced PG in the peritoneal cavity between the gastric and abdominal walls and developed peritonitis that had to be surgically treated. The minor complication rate was 34% (17 of 50) in the PG group. In the MG group, the major complication rate was 0%, and the minor complication rate was 12.2% (6 of 49). The most common minor complication was tube occlusion. Minor complication rate was significantly higher in the PG group (P = .016). Mean fluoroscopy time was significantly longer in the MG group (P = .013). CONCLUSIONS Both PG and MG demonstrated high technical success rates in all indications. MG had lower complication rates than PG at the cost of an increase in fluoroscopy times.
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Affiliation(s)
- Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea.
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Yong Seek Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Woosun Choi
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Do Yun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
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Haber ZM, Charles HW, Gross JS, Pflager D, Deipolyi AR. Percutaneous radiologically guided gastrostomy tube placement: comparison of antegrade transoral and retrograde transabdominal approaches. Diagn Interv Radiol 2017; 23:55-60. [PMID: 27911264 DOI: 10.5152/dir.2016.15626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE We aimed to compare the antegrade transoral and the retrograde transabdominal approaches for fluoroscopy-guided percutaneous gastrostomy tube (G-tube) placement. METHODS Following institutional review board approval, all G-tubes at two academic hospitals (January 2014 to May 2015) were reviewed retrospectively. Retrograde approach was used at Hospital 1 and both antegrade and retrograde approaches were used at Hospital 2. Chart review determined type of anesthesia used during placement, dose of radiation used, fluoroscopy time, procedure time, medical history, and complications. RESULTS A total of 149 patients (64 women, 85 men; mean age, 64.4±1.3 years) underwent G-tube placement, including 93 (62%) placed via the retrograde transabdominal approach and 56 (38%) placed via the antegrade transoral approach. Retrograde placement entailed fewer anesthesiology consultations (P < 0.001), less overall procedure time (P = 0.023), and less fluoroscopy time (P < 0.001). A comparison of approaches for placement within the same hospital demonstrated that the retrograde approach led to significantly reduced radiation dose (P = 0.022). There were no differences in minor complication rates (13%-19%; P = 0.430), or major complication rates (6%-7%; P = 0.871) between the two techniques. CONCLUSION G-tube placement using the retrograde transabdominal approach is associated with less fluoroscopy time, procedure time, radiation exposure, and need for anesthesiology consultation with similar safety profile compared with the antegrade transoral approach. Additionally, it is hypothesized that decreased procedure time and anesthesiology consultation using the transoral approach are likely associated with reduced cost.
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Affiliation(s)
- Zachary M Haber
- Division of Vascular and Interventional Radiology Department of Radiology, NYU Langone Medical Center, New York, NY, USA.
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Sheth RA, Koottappillil B, Kambadakone A, Ganguli S, Thabet A, Mueller PR. A Quality Improvement Initiative to Reduce Catheter Exchange Rates for Fluoroscopically Guided Gastrostomy Tubes. J Vasc Interv Radiol 2015; 27:251-9. [PMID: 26656959 DOI: 10.1016/j.jvir.2015.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/12/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of a data-driven quality improvement initiative to reduce catheter exchange rates. MATERIALS AND METHODS A single-institution retrospective analysis of all percutaneous radiologic gastrostomy (PRG) placement and replacement procedures between January 2010 and July 2015 was conducted. A statistical model predicting the risk for catheter exchange for any reason and exchanges specifically for tube malfunction was created; a quality improvement plan to reduce catheter exchanges was designed and implemented in June 2014. The outcomes for subsequent PRG procedures from July 2014 through March 2015 were followed until July 2015. RESULTS Between 2010 and June 2014, 1,144 primary PRG procedures and 442 replacement procedures were performed in 1,112 patients. Of the 442 exchange procedures, 289 were "rescue" procedures secondary to catheter malfunction. A quality improvement plan was implemented in June 2014 that encouraged primary gastrojejunostomy catheter and balloon-retained PRG catheter placement and placement of skin sutures in patients considered high risk for catheter dislodgment. From July 2014 through March 2015, 229 PRG catheters were placed, and 71 exchange procedures were performed through July 2015. There was a statistically significant decrease in the number of rescue exchanges performed secondary to catheter malfunction (P = .036). CONCLUSIONS Procedural and patient-specific risk factors for PRG complications were identified, and a statistical model to predict rates of minor complications was created. These findings were used to implement a quality improvement program that resulted in a decrease in PRG exchanges secondary to catheter malfunction.
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Affiliation(s)
- Rahul A Sheth
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114.
| | - Brian Koottappillil
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114
| | - Avinash Kambadakone
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114
| | - Ashraf Thabet
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114
| | - Peter R Mueller
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114
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Bernstein OA, Campbell J, Rajan DK, Kachura JR, Simons ME, Beecroft JR, Jaskolka JD, Ringash J, Ho CS, Tan KT. Randomized Trial Comparing Radiologic Pigtail Gastrostomy and Peroral Image-Guided Gastrostomy: Intra- and Postprocedural Pain, Radiation Exposure, Complications, and Quality of Life. J Vasc Interv Radiol 2015; 26:1680-6; quiz 1686. [PMID: 26316137 DOI: 10.1016/j.jvir.2015.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/12/2015] [Accepted: 07/15/2015] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To prospectively compare radiologically created pigtail gastrostomy (PG), in which the tube is inserted directly through the abdominal wall, versus peroral image-guided gastrostomy (POG), in which the tube is inserted through the mouth. Pain profiles (primary outcome measure), fluoroscopy times, total room times, technical success, complications, and quality of life (QOL) were measured. MATERIALS AND METHODS Sixty patients were prospectively randomized to receive 14-F PG or 20-F POG tubes. All patients received prophylactically created gastrostomies before radiation therapy for head and neck squamous-cell carcinoma. Patients receiving palliative treatment were excluded, as were those with established pharyngeal obstruction. Pain was measured by numeric rating scale (NRS) scores for 6 weeks after the procedure and by intraprocedural fentanyl and midazolam doses and postprocedural 24-h morphine doses. Fluoroscopy times, total room times, technical success, complications up to 6 months, and gastrostomy-related QOL (using the Functional Assessment of Cancer Therapy-Enteral Feeding questionnaire) were determined. RESULTS Fifty-six patients underwent the randomized procedure. The POG group required significantly higher intraprocedural midazolam and fentanyl doses (mean, 1.2 mg and 67 μg, respectively, for PG vs 1.9 mg and 105 μg for POG; P < .001) and had significantly longer fluoroscopy times (mean, 1.3 min for PG vs 4.8 min for POG; P < .0001). NRS scores, morphine doses, total room times, technical success, complication rates, and QOL did not differ significantly between groups. The one major complication, a misplaced PG in the peritoneal cavity, followed a technical failure of POG creation. CONCLUSIONS Despite the differences in insertion technique and tube caliber, the measured outcomes of POG and PG are comparable.
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Affiliation(s)
- Ondina A Bernstein
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada.
| | - Jennifer Campbell
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Dheeraj K Rajan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - John R Kachura
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Martin E Simons
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - J Robert Beecroft
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey D Jaskolka
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Chia S Ho
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Kong Teng Tan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
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13
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Ahmed O, Jilani D, Sheth S, Giger M, Funaki B. Radiologically Guided Placement of Mushroom-retained Gastrostomy Catheters: Long-term Outcomes of Use in 300 Patients at a Single Center. Radiology 2015; 276:588-96. [PMID: 25775194 DOI: 10.1148/radiol.15141327] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess long-term outcomes including risk of complications and nutritional benefits of mushroom-retained (pull-type) gastrostomy catheters placed in patients by interventional radiologists. MATERIALS AND METHODS All patients who received pull-type gastrostomy tubes between 2010 and 2013 were retrospectively reviewed, including 142 men (average weight, 169.6 lb [76.32 kg]; mean age, 65.2 years; range, 22-92 years) and 158 women (average weight, 150.4 lb [67.68 kg]; mean age, 65.2 years; range, 18-98 years). Indications for placement were cerebrovascular accident (n = 80), failure to thrive (n = 71), other central nervous system disorder (n = 51), head and neck cancer (n = 47), and other malignancy (n = 51). Complications were recorded per Society of Interventional Radiology practice guidelines. Patient weight was documented at specific follow-up intervals. Statistical analysis was performed by using the Student t test and one-way analysis of variance for the effects of sex and indication for placement, respectively, on average weight change. RESULTS The technical success rate was 98.4% (300 of 305 patients). Major and minor complications occurred at a rate of 3.7% (n = 11) and 13% (n = 39), respectively. Follow-up weight during the early (≤45 days), intermediate (≤180 days), and long-term (>180 days) periods was available for 71% (n = 214), 36% (n = 108), and 15% (n = 44) of the 300 patients, respectively. Weight gain occurred in 77% (160 of 214), 60% (65 of 108), and 73% (32 of 44) of the patients, respectively. Patients who gained weight gained 6.7, 10.6, and 16.3 lb (3.02, 4.77, and 7.34 kg) during each follow-up period, respectively. Average weight gain at follow-up in all patients was 4.2, 0.6, and 5.4 lb (1.89, 0.27, and 2.43 kg), respectively. No significant differences in average weight change were seen among groups when they were classified according to sex or indication for placement. CONCLUSION Placement of mushroom-retained gastrostomy catheters is a viable long-term treatment option for enteral nutrition, with complication rates similar to those reported for other gastrostomy techniques. Improvement in nutrition status measured as weight gain was seen in most patients in both early and long-term periods.
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Affiliation(s)
- Osman Ahmed
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Danial Jilani
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Sujay Sheth
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Maryellen Giger
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Brian Funaki
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
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Kim CY, Engstrom BI, Horvath JJ, Lungren MP, Suhocki PV, Smith TP. Comparison of primary jejunostomy tubes versus gastrojejunostomy tubes for percutaneous enteral nutrition. J Vasc Interv Radiol 2013; 24:1845-52. [PMID: 24094674 DOI: 10.1016/j.jvir.2013.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/15/2013] [Accepted: 08/20/2013] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate technical success and long-term outcomes of percutaneous primary jejunostomy tubes for postpyloric enteral feeding compared with percutaneous gastrojejunostomy (GJ) tubes. MATERIALS AND METHODS Over a 25-month interval, 41 consecutive patients (26 male; mean age, 55.9 y) underwent attempted fluoroscopy-guided direct percutaneous jejunostomy tube insertion. Insertions at previous jejunostomy tube sites were excluded. The comparison group consisted of all primary GJ tube insertions performed over a 12-month interval concomitant with the jejunostomy tube interval (N = 169; 105 male; mean age, 59.4 y). Procedural, radiologic, and clinical data were retrospectively reviewed. Intervention rates were expressed as events per 100 catheter-days. RESULTS The technical success rate for percutaneous jejunostomy tube insertion was 96%, versus 93% for GJ tubes (P = .47). Mean fluoroscopy times were similar for jejunostomy and GJ tubes (9.8 vs 10.0 min, respectively; P value not significant). Jejunostomy tubes exhibited a lower rate of catheter dysfunction than GJ tubes, with catheter exchange rates of 0.24 versus 0.93, respectively, per 100 catheter-days (P = .045). GJ tube tip retraction into the stomach occurred in 9.5% of cases, at a rate of 0.21 per 100 catheter-days. Intervention rates related to leakage were 0.19 and 0.03 for jejunostomy and GJ tubes, respectively (P < .01). Jejunostomy and GJ tubes exhibited similar rates of catheter exchange for occlusion and replacement as a result of inadvertent removal. No major complications were encountered in either group. CONCLUSIONS Percutaneous insertion of primary jejunostomy tubes demonstrated technical success and complication rates similar to those of GJ tubes. Jejunostomy tubes exhibited a lower dysfunction rate but a higher leakage rate compared with GJ tubes.
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Affiliation(s)
- Charles Y Kim
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
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Fujita T, Tanabe M, Kobayashi T, Washida Y, Kato M, Iida E, Shimizu K, Matsunaga N. Percutaneous gastrostomy tube placement using a balloon catheter in patients with head and neck cancer. JPEN J Parenter Enteral Nutr 2012; 37:117-22. [PMID: 22368096 DOI: 10.1177/0148607111435264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with head and neck cancer frequently require gastrostomy feeding. The aim of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy with push-type gastrostomy tubes using a rupture-free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance in patients with head and neck cancer with swallowing disturbance or trismus. METHODS Percutaneous CT and fluoroscopic gastrostomy placement of push-type gastrostomy tubes using a RFB catheter was performed in consecutive patients with head and neck cancer between April 2007 and July 2010. The technical success, procedure duration, and major or minor complications were evaluated. RESULTS Twenty-one patients (14 men, 7 women; age range, 55-78 years; mean age, 69.3 years) underwent gastrostomy tube placement. The tumor location was the pharynx (n = 8), oral cavity (n = 7), and gingiva (n = 6). Gastrostomy was performed in 15 patients during treatment and 6 patients after treatment. Percutaneous radiologic gastrostomy was technically successful in all patients. The median procedure time was 35 ± 19 (interquartile range) minutes (range, 25-75). The average follow-up time interval was 221 days (range, 10-920 days). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow-up periods. CONCLUSION Percutaneous CT and fluoroscopic-guided gastrostomy with push-type tubes using a RFB catheter is a relatively safe and effective means of gastric feeding, with high success and low complication rates in patients with head and neck cancer in whom endoscopy was not feasible.
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Affiliation(s)
- Takeshi Fujita
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
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Multidisciplinary Practical Guidelines for Gastrointestinal Access for Enteral Nutrition and Decompression From the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, With Endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). J Vasc Interv Radiol 2011; 22:1089-106. [DOI: 10.1016/j.jvir.2011.04.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 04/08/2011] [Accepted: 04/08/2011] [Indexed: 12/16/2022] Open
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Itkin M, DeLegge MH, Fang JC, McClave SA, Kundu S, d'Othee BJ, Martinez-Salazar GM, Sacks D, Swan TL, Towbin RB, Walker TG, Wojak JC, Zuckerman DA, Cardella JF. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Gastroenterology 2011; 141:742-65. [PMID: 21820533 DOI: 10.1053/j.gastro.2011.06.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/08/2011] [Indexed: 02/06/2023]
Affiliation(s)
- Maxim Itkin
- Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, Pennsylvania Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
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Comparison of fluoroscopy-guided Pull-type percutaneous radiological gastrostomy (Pull-type-PRG) with conventional percutaneous radiological gastrostomy (Push-type-PRG): clinical results in 253 patients. Eur Radiol 2011; 21:2354-61. [PMID: 21739349 DOI: 10.1007/s00330-011-2194-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/16/2011] [Accepted: 05/19/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To analyze the clinical results and complications of fluoroscopy guided internal-external Pull-type percutaneous radiological gastrostomy (Pull-type-PRG) and conventional external-internal percutaneous radiological gastrostomy (Push-type-PRG). METHODS A total of 253 patients underwent radiological gastrostomy between January 2002 and January 2010. Data were collected retrospectively from radiology reports, Chart review of clinical notes, procedure reports, discharge summaries and subsequent hospital visits. Statistical analysis was performed to compare the two methods for gastrostomy with respect to peri-interventional aspects and clinical results. RESULTS 128 patients received the Pull-type-PRG whereas the other 125 patients were served with the Push-type-PRG. Indications for gastrostomy were similar in these two groups. The most frequent indications for the both methods were stenotic oesophageal tumors or head/neck tumors (54.7% in Pull-type-PRG, 68% in Push-type-PRG). Gastrostomy procedures were successful in 98.3% in Pull-type-PRG compared to 92% in Push-type-PRG. There was no procedure-related mortality. Compared to Push-type-PRG, the peri-interventional complication rate was significantly reduced in Pull-type-PRG (14.8% versus 34.4%, P = 0.002). CONCLUSIONS Compared to the external-internal Push-type-PRG, the internal-external Pull-type-PRG showed a high primary success rate and a decreased incidence of peri-interventional complications.
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Initial experience with computed tomography and fluoroscopically guided placement of push-type gastrostomy tubes using a rupture-free balloon catheter. Cardiovasc Intervent Radiol 2010; 34:626-30. [PMID: 20661571 DOI: 10.1007/s00270-010-9917-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 05/28/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy placement of push-type gastrostomy tubes using a rupture-free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance. A total of 35 patients (23 men and 12 women; age range 57-93 years [mean 71.7]) underwent percutaneous CT and fluoroscopically guided gastrostomy placement of a push-type gastrostomy tube using an RFB catheter between April 2005 and July 2008. Technical success, procedure duration, and complications were analyzed. Percutaneous radiologic gastrostomy placement was considered technically successful in all patients. The median procedure time was 39±13 (SD) min (range 24-78). The average follow-up time interval was 103 days (range 7-812). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow-up period. The investigators conclude that percutaneous CT and fluoroscopically guided gastrostomy placement with push-type tubes using an RFB catheter is a safe and effective means of gastric feeding when performed by radiologists.
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Thoracic and abdominal devices radiologists should recognize: pictorial review. AJR Am J Roentgenol 2009; 193:S106-18. [PMID: 19933675 DOI: 10.2214/ajr.07.7146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Surgical, interventional, and diagnostic devices are continually being developed and often have unexpected radiographic appearances. The purpose of this article is to familiarize the radiologist with several devices that may be placed in the thorax and abdomen. CONCLUSION The radiologist's familiarity with the radiographic appearance of devices placed in the chest and abdomen is essential for accurate image interpretation and identification of postprocedure complications.
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Afthinos JN, Latif MJ, Bhora FY, Connery CP, McGinty JJ, Burra A, Attiyeh M, Todd GJ, Belsley SJ. What technical barriers exist for real-time fluoroscopic and video image overlay in robotic surgery? Int J Med Robot 2008; 4:368-72. [DOI: 10.1002/rcs.221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Blondet A, Lebigot J, Nicolas G, Person B, Laccoureye L, Goura E, Ridereau-Zins C, Aubé C. Gastrostomie Percutanée Radiologique. ACTA ACUST UNITED AC 2008; 89:1065-75. [DOI: 10.1016/s0221-0363(08)73910-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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