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Geng X, Zhao Q, Yuan H, Li HL, Guo CY, Yang T, Fan WJ, Park JH, Zhao XH, Zhu WB, Hu HT. The important role of whole-process computed tomography guidance for percutaneous gastrostomy in esophageal cancer patients who are unsuitable for or have had unsuccessful attempts with endoscopic and fluoroscopic gastrostomy. BMC Gastroenterol 2024; 24:14. [PMID: 38172745 PMCID: PMC10765879 DOI: 10.1186/s12876-023-03040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE To explore the value of clinical application with the whole process computed tomography (CT) guided percutaneous gastrostomy in esophageal tumor patients. MATERIALS AND METHODS A consecutive series of 32 esophageal tumor patients in whom endoscopic gastrostomy or fluoroscopy guided gastrostomy were considered too dangerous or impossible due to the esophagus complete obstruction, complicate esophageal mediastinal fistula, esophageal trachea fistula or severe heart disease. All of the 32 patients were included in this study from 2 medical center and underwent the gastrostomy under whole process CT guided. RESULTS All of the gastrostomy procedure was finished successfully under whole process CT guided and the technical success rate was 100%. The average time for each operation was 27 min. No serious complications occurred and the minor complications occurred in 3 patients, including local infection, severe hyperplasia of granulation tissue and tube dislodgment. There were no procedure related deaths. CONCLUSION The technical success rate of whole process CT guided percutaneous gastrostomy is high and the complication is low. This technique can be used feasible and effectively in some special patients.
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Affiliation(s)
- Xiang Geng
- Department of Minimally & Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, NO.127, Dongming Road, Zhengzhou, 450008, Henan Province, China
| | - Qing Zhao
- Department of Radiology, The Second People's Hospital of Jiaozuo, NO.17, Minzhu South Road, Jiaozuo, 454150, Henan Province, China
| | - Hang Yuan
- Department of Minimally & Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, NO.127, Dongming Road, Zhengzhou, 450008, Henan Province, China
| | - Hai-Liang Li
- Department of Minimally & Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, NO.127, Dongming Road, Zhengzhou, 450008, Henan Province, China
| | - Chen-Yang Guo
- Department of Minimally & Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, NO.127, Dongming Road, Zhengzhou, 450008, Henan Province, China
| | - Ting Yang
- Department of Radiology, The Second People's Hospital of Jiaozuo, NO.17, Minzhu South Road, Jiaozuo, 454150, Henan Province, China
| | - Wei-Jun Fan
- Department of Minimally & Invasive Intervention, Sun Yat-sen University Cancer Center, NO.651, Dongfeng east Road, Guangzhou, 510000, Guangdong Province, China
| | - Jung-Hoon Park
- Biomedical Engineering Rearch Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43- gil, Seoul, 05505, Korea
| | - Xiao-Hui Zhao
- Department of Minimally & Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, NO.127, Dongming Road, Zhengzhou, 450008, Henan Province, China
| | - Wen-Bo Zhu
- Department of Minimally & Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, NO.127, Dongming Road, Zhengzhou, 450008, Henan Province, China
| | - Hong-Tao Hu
- Department of Minimally & Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, NO.127, Dongming Road, Zhengzhou, 450008, Henan Province, China.
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Bakdık S, Keskin M, Öncü F, Koç O. Radiology guided antegrade GASTROSTOMY deployment of mushroom (pull type) catheters with classical and modified methods in patients with oropharyngeal, laryngeal carcinoma, and anesthesia risk. Br J Radiol 2021; 94:20201130. [PMID: 34478337 PMCID: PMC8553181 DOI: 10.1259/bjr.20201130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/03/2021] [Accepted: 08/16/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim of study is to evaluate the results of deployment of Percutaneous Radiological Gastrostomy (PRG), which is a good alternative to Surgical Gastrostomy (SG), with transoral approach in cases where Percutaneous Endoscopic Gastrostomy (PEG) is contraindicated, difficult or unsuccessful, in patients with high risk of American Society of Anesthesiologists with four scores. In addition, we aimed to demonstrate the advantages of mushroom pull type catheters over push type gastrostomy catheters. METHODS This retrospective study included a total of 40 patients (18 females and 22 males) aged 21-92 years who underwent PRG with the antegrade transoral approach. PRG was performed by retrograde passing through the esophagus or snaring the guidewire from the stomach and taking out of the anterior abdominal wall. Patients' demographic data, indications for PRG, procedural outcomes and complications were screened and recorded. RESULTS PRG was performed in 39 of 40 patients included in the study. Technical success rate was 97.5%. Procedure-dependent major complications such as death, aspiration, colon perforation, and deep abscess were not observed. Aspiration occurred in the first patient during the first feeding on the day after the procedure. Major complication rate was 2.5%. The total minor complication rate was 17.5% in 7 patients; parastomal leakage in 2 patients (5%), skin rash and infection in 3 (7.5%) patients, minor bleeding in 2 (5%) patients with oropharynx cancer, minimal bleeding from the gastrostomy catheter 1 week after the procedure in 1 (2.5%) patient. None of the cases had buried buffer. Tube functionality was preserved in all patients without any damage. CONCLUSION Mushroom tip (pull type) gastrostomy catheter is a safe treatment method for patients requiring prolonged feeding because of wide diameter, endurance, long staying opening duration, less excessive dilatation and parastomal leakage, and no need for gastropexy. Lower cost and easier access are advantageous for mushroom tip pull type catheters compared to push type gastrostomy catheters in our country. The less invasive PRG is an alternative option in patients who are difficult to administer PEG, are at high anesthesia risk and cannot be sedated. ADVANCES IN KNOWLEDGE This article is valuable in terms of its contribution to develop an alternative radiological method for the deployment of gastrostomy tubes in medical difficult patients. This method has shortened the duration of the procedure and increased the success rate in patients with difficulty in transition from the stomach to the esophagus or with difficulty in the upper gastrointestinal tract. Mushroom tip catheters can be placed successfully by radiological methods.
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Affiliation(s)
- Süleyman Bakdık
- Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Meram, Turkey
| | - Muharrem Keskin
- Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Meram, Turkey
| | - Fatih Öncü
- Department of Radiology, School of Medicine, Gazi University, Ankara, Turkey
| | - Osman Koç
- Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Meram, Turkey
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Patel NR, Bailey S, Tai E, Mirrahimi A, Mafeld S, Beecroft JR, Tan KT, Annamalai G. Randomized Controlled Trial of Percutaneous Radiologic Gastrostomy Performed With and Without Gastropexy: Technical Success, Patient-Reported Outcomes and Safety. Cardiovasc Intervent Radiol 2021; 44:1081-1088. [PMID: 33709271 DOI: 10.1007/s00270-021-02806-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/12/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of this study is to compare balloon-retention percutaneous radiologic gastrostomy (PRG) tube insertion performed with and without gastropexy, primarily focusing on pain and patient-reported outcomes. MATERIALS AND METHODS Research ethics board approved a dual-arm, single-centre, randomized trial of 60 patients undergoing primary 14-French PRG tube insertion (NCT04107974). Patients were randomized to receive either PRG with gastropexy or without gastropexy. Data were collected for technical outcomes, patient-reported outcomes pre-procedure, post-procedure and at 1-month, as well as quality of life parameters at 1-month post-procedure (EQ5D-5L, Visual Analogue Scale and Functional Assessment of Cancer Therapy-Enteral Feeding questionnaires). Complications occurring up to 6-months post-procedure were recorded. RESULTS Sixty patients were randomized to the gastropexy group (n = 30) or non-gastropexy (n = 30) group. One non-gastropexy patient was withdrawn from the study due to failed insertion. PRG procedural time was significantly longer when using gastropexy (mean 11.4 ± 7.19 min) compared with non-gastropexy (mean 6.79 ± 4.63 min; p < 0.05). Pain scores did not differ between the two groups pre-procedure, post-procedure and at 1-month follow-up, nor did 1-month quality of life parameters. Six (20%) minor complications occurred in the gastropexy group and nine (31%) minor complications in the non-gastropexy group (p = 0.330). Two (6.9%) major complications occurred in the non-gastropexy group (p = 0.458). CONCLUSION There is comparable patient tolerability when balloon-retention PRG insertion is performed with or without gastropexy sutures. This study also demonstrated a trend towards fewer complications when gastropexy is utilized. However, further larger trials are required to compare complications of the two approaches for PRG insertion. LEVEL OF EVIDENCE Level 2, randomized trial.
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Affiliation(s)
- Neeral R Patel
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada.
| | - Shawn Bailey
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Elizabeth Tai
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Arash Mirrahimi
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Sebastian Mafeld
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - J Robert Beecroft
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Kong Teng Tan
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Ganesan Annamalai
- Division of Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
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Kim R, Park HS, Do YS, Park KB, Shin SW, Cho SK, Hyun DH, Choo SW. Percutaneous radiologic gastrostomy with single gastropexy: outcomes in 636 patients. Eur Radiol 2021; 31:6531-6538. [PMID: 33655409 DOI: 10.1007/s00330-021-07762-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/09/2021] [Accepted: 02/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to assess the technical success and overall complication rate of percutaneous radiologic gastrostomy (PRG) with single gastropexy using a separate tract from that used for tube placement. METHODS From January 2014 to December 2018, 636 patients (469 men, 167 women; mean age 66.8 years; age range, 22-98 years) underwent PRG using single gastropexy at a tertiary center. Preprocedural computed tomography (CT) was recommended if there were no data on the location of the stomach on previous CT. After a single anchor was applied, the PRG tube was inserted through a separate tract from that used for tube placement. The technical success rate and major and minor complications were retrospectively reviewed. The number of patients and percentages were used as descriptive statistics for evaluating the complication rate. RESULTS The technical success rate of PRG with single gastropexy was 99.2% (631/636). There were 32 complications among the 631 procedures. There were 19 (3.0%) major complications, including peritonitis (n = 7), migration (n = 5), infection (n=4), malposition (n = 2), and bleeding (n = 1). There were 13 (2.1%) minor complications, including local infection (n = 11), malfunction (n = 1), and pneumoperitoneum (n = 1). The overall complication rate within 30 days of PRG placement was 4.1% (26/631). CONCLUSIONS PRG with single gastropexy using a separate tract from that used for tube placement is technically feasible with a low complication rate. KEY POINTS • Percutaneous radiologic gastrostomy with single gastropexy using a separate tract from that used for tube placement is technically feasible. • Complications including peritonitis and bleeding were comparatively low with the conventional technique.
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Affiliation(s)
- Ran Kim
- Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam Gu, Seoul, 06351, Korea.
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam Gu, Seoul, 06351, Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam Gu, Seoul, 06351, Korea
| | - Sung Wook Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam Gu, Seoul, 06351, Korea
| | - Sung Ki Cho
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam Gu, Seoul, 06351, Korea
| | - Dong Ho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam Gu, Seoul, 06351, Korea
| | - Sung Wook Choo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam Gu, Seoul, 06351, Korea
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Park JH, Cho YC, Shin JH, Nouri Y, Kim JW, Kim JH, Ko HK. Temporary percutaneous radiologic gastrojejunostomy with single gastropexy. Acta Radiol 2021; 62:329-333. [PMID: 32517532 DOI: 10.1177/0284185120929707] [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: 11/16/2022]
Abstract
BACKGROUND Although the effectiveness of percutaneous radiologic gastrojejunostomy (PRGJ) has been reported, a detailed description of the indications and clinical effectiveness of temporary PRGJ is still limited. PURPOSE To evaluate the clinical effectiveness and technical feasibility of temporary PRGJ using the modified Chiba-needle technique with single gastropexy. MATERIAL AND METHODS Temporary PRGJ using the modified Chiba-needle technique with single gastropexy was performed in 27 consecutive patients (19 men, 8 women; mean age = 61 years; age range = 32-77 years) for esophageal perforation (n = 18) or postoperative gastroparesis (n = 9). Outcomes analyzed included the technical and clinical success, procedure-related complications, and the tube indwelling period. RESULTS Technical and clinical success was achieved in all 27 patients. All the tubes were electively removed 19-364 days (mean indwelling period = 104 days) after confirmation of the possibility of oral intake. Asymptomatic pneumoperitoneum occurred in 2/27 (7.4%) patients as minor complications and was resolved spontaneously by the time of the one-week follow-up. There were no major complications. During the follow-up period, a total of 11 tube changes were performed in seven patients for an elective tube change within a six-month interval (n = 5) or because of tube occlusion (n = 6). CONCLUSION Temporary PRGJ using the modified Chiba-needle technique with a single gastropexy was clinically effective and technically feasible in patients with esophageal perforation or gastroparesis. It can provide adequate enteral nutrition during its temporary placement.
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Affiliation(s)
- Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Republic of Korea
| | - Young Chul Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yasir Nouri
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Gkolfakis P, Arvanitakis M, Despott EJ, Ballarin A, Beyna T, Boeykens K, Elbe P, Gisbertz I, Hoyois A, Mosteanu O, Sanders DS, Schmidt PT, Schneider SM, van Hooft JE. Endoscopic management of enteral tubes in adult patients - Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:178-195. [PMID: 33348410 DOI: 10.1055/a-1331-8080] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
ESGE recommends the "pull" technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer ("push") technique for PEG placement in cases where the "pull" method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed "blindly" at the patient's bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 - 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 - 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.
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Affiliation(s)
- Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Edward J Despott
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, United Kingdom
| | - Asuncion Ballarin
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Torsten Beyna
- Department of Gastroenterology and Therapeutic Endoscopy, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Kurt Boeykens
- Nutrition Support Team, AZ Nikolaas Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
| | - Peter Elbe
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Gisbertz
- Department of Gastroenterology, Bernhoven Hospital, Uden, the Netherlands
| | - Alice Hoyois
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ofelia Mosteanu
- Department of Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, United Kingdom
| | - Peter T Schmidt
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Stéphane M Schneider
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Gastroentérologie et Nutrition, Nice, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Percutaneous Gastrojejunostomy Tube Insertion in Patients with Surgical Gastrojejunal Anastomoses: Analysis of Success Rates and Durability. J Vasc Interv Radiol 2020; 32:277-281. [PMID: 33160829 DOI: 10.1016/j.jvir.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022] Open
Abstract
Patients with a gastrojejunal anastomosis pose challenging anatomy for percutaneous gastrojejunostomy (GJ)-tube placement. A retrospective review of 24 patients (mean age 67.8 years, 13 males) with GJ anastomoses who underwent attempted GJ tube placement revealed infeasible placement in 6 patients (25%) due to an inadequate window for puncture. When a gastric puncture was achieved, GJ tube insertion was technically successful in 83% (15/18) of attempts, resulting in an overall technical success rate of 63% (15/24). The most common tube-related complication was the migration of the jejunal limb into the stomach, which occurred in 40% (6/15) of successful cases. No major procedure related complications were encountered.
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Abstract
Enteral access is the foundation for feeding in patients unable to meet their nutrition needs orally and have a functional gastrointestinal tract. Enteral feeding requires placement of a feeding tube. Tubes can be placed through an orifice or percutaneously into the stomach or proximal small intestine at the bedside or in specialized areas of the hospital. Bedside tubes can be placed by the nurse or the physician, such as in the intensive care unit. Percutaneous feeding tubes are placed by the gastroenterologist, surgeon, or radiologist. This article reviews the types of enteral access and the associated complications.
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Affiliation(s)
- Mark H DeLegge
- Department of Medicine, Medical University of South Carolina, 25 Courtenay Street, Charleston, SC 29425, USA; DeLegge Medical, 4057 Longmarsh Road, Awendaw, SC 29429, USA.
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9
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Miller ZA, Mohan P, Tartaglione R, Narayanan G. Bowel Obstruction: Decompressive Gastrostomies and Cecostomies. Semin Intervent Radiol 2017; 34:349-360. [PMID: 29249859 DOI: 10.1055/s-0037-1608706] [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: 10/18/2022]
Abstract
Over the past 30 years, image-guided placement of gastrostomies and cecostomies for gastrointestinal decompression has developed into a safe and effective treatment for symptomatic bowel obstruction. Gastrostomies and cecostomies relieve patient symptoms, can prevent serious complications such as colonic perforation, and may bridge patients to more definitive treatment for the underlying cause of obstruction. This article will review the history of decompressive gastrostomies and cecostomies as well as the indications, contraindications, technique, complications, and outcomes of these procedures.
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Affiliation(s)
- Zoe A Miller
- Department of Interventional Radiology, University of Miami-Miller School of Medicine, Miami, Florida
| | - Prasoon Mohan
- Department of Interventional Radiology, University of Miami-Miller School of Medicine, Miami, Florida
| | - Robert Tartaglione
- Department of Interventional Radiology, University of Miami-Miller School of Medicine, Miami, Florida
| | - Govindarajan Narayanan
- Department of Interventional Radiology, University of Miami-Miller School of Medicine, Miami, Florida
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Kahriman G, Ozcan N, Donmez H. Fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes in 102 patients. Diagn Interv Imaging 2017; 98:715-720. [PMID: 28416390 DOI: 10.1016/j.diii.2017.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the technical and clinical results of fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes. MATERIALS AND METHODS This retrospective study included 102 patients (61 men, 41 women) with a mean age of 59years±16.3 (SD) (range, 18-94years) who had fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes. All procedures were performed after inflating the stomach with air via an orally inserted 5-Fr catheter by retrograde catheterization of the esophagogastric junction. Demographic data, results of the procedures and complications were evaluated. RESULTS A technical success was observed in 101/102 patients, yielding a technical success rate of 99%. Complications due to the procedure were observed in 17/102 patients yielding a procedure-related complication rate of 16.7%. Procedure-related complications included peristomal superficial cellulitis (6/102; 5.9%), peristomal abscess (4/102; 3.9%), subcutaneous hematoma (3/102; 2.9%), peristomal leakage (2/102; 2%), inadvertent removal of the tube (1/102; 1%) and death due to procedure-related peritonitis (1/102; 1%). CONCLUSION Fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes is a feasible and effective method for enteral nutrition.
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Affiliation(s)
- G Kahriman
- Erciyes University, Medical Faculty, Gevher Nesibe Hospital, Department of Radiology, 38039, Kayseri, Turkey.
| | - N Ozcan
- Erciyes University, Medical Faculty, Gevher Nesibe Hospital, Department of Radiology, 38039, Kayseri, Turkey.
| | - H Donmez
- Erciyes University, Medical Faculty, Gevher Nesibe Hospital, Department of Radiology, 38039, Kayseri, Turkey.
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11
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Busch JD, Herrmann J, Adam G, Habermann CR. Radiologically inserted gastrostomy: differences of maintenance of balloon- vs. loop-retained devices. Scand J Gastroenterol 2016; 51:1423-1428. [PMID: 27687634 DOI: 10.1080/00365521.2016.1216590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare outcome and associated complications of ballon- vs. loop-retained devices for radiologically inserted gastrostomy (RIG). METHODS From 2007 to 2011 233 patients (age 63.7 ± 10.6 years) were referred for a RIG because of pharyngeal stricture Intervention was performed with four different devices: balloon-retained - Freka® GastroTube, Fresenius Kabi (n = 121); MIC® Gastrostomy Feeding Tube, Kimberly-Clark (n = 34); Russell® Gastrostomy Tray, Cook Medical Inc. (n = 17); and loop-retained - Tilma® Gastrostomy Set, Cook Medical Inc. (n = 50). Follow-up was performed with regard to RIG-related complications, cause of removal and fatalities. Revision-free survival times after RIG were evaluated using Kaplan-Meier analysis and group differences by log-rank tests. For analysis of demographic and methodical variables multivariate Cox regression models were used. RESULTS With a primary technical success rate of 95.3% (222/233) a total of 92 instances of revisions were necessary in 66 patients (66/233, 28.3%) during follow-up (mean 182.8 ± 86.6 days). The most common complication was tube dislodgement (14.3%). There were no significant differences between the distinct devices (p = 0.098), but analyzing the data in subgroups of balloon-compared to loop-retained gastrostomy tubes we observed a significantly higher probability of minor complications for the latter (p = 0.023). CONCLUSION As it is significantly less prone to minor complications we recommend the use of balloon-retained gastrostomy tubes to improve the practicability and maintenance of RIG.
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Affiliation(s)
- J D Busch
- a Department of Diagnostic and Interventional Radiology and Nuclear Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany.,b Department of Diagnostic and Interventional Radiology and Nuclear Medicine , Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - J Herrmann
- a Department of Diagnostic and Interventional Radiology and Nuclear Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany.,b Department of Diagnostic and Interventional Radiology and Nuclear Medicine , Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - G Adam
- a Department of Diagnostic and Interventional Radiology and Nuclear Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - C R Habermann
- c Catholic Marienkrankenhaus GmbH , Institute of Diagnostic and Interventional Radiology , Hamburg , Germany
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Bendel EC, McKusick MA, Fleming CJ, Friese JL, A Woodrum D, Stockland AH, Misra S. Percutaneous radiologic gastrostomy catheter placement without gastropexy: a co-axial balloon technique and evaluation of safety and efficacy. Abdom Radiol (NY) 2016; 41:2227-2232. [PMID: 27344156 DOI: 10.1007/s00261-016-0808-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the short-term safety and efficacy of a co-axial angioplasty balloon technique for percutaneous radiologic gastrostomy catheter placement (PRG). METHODS A total of 65 percutaneous radiologic gastrostomy tube placements were performed with the co-axial angioplasty balloon technique from 10/1999 to 1/2014. This included 19 females and 46 males between the ages of 20-83. Without the use of T-fasteners for gastropexy, the gastrostomy tube was placed over a catheter-shaft angioplasty balloon as a co-axial system. The angioplasty balloon was used to sequentially approximate the stomach wall to the abdominal wall, dilate the tract, and was then used as a dilator to aid gastrostomy tube advancement into the gastric lumen. Technical success, complications, and dislodgements were evaluated by means of retrospective review of patient medical records and imaging. RESULTS There was no procedural failure in any of the 65 placements. 30-day follow-up was available for 56 patients. 7 patients died within 30 days; none of the deaths were recorded as procedure-related. There was 1 major complication (1.5%) consisting of a colocutaneous fistula. There were 4 minor complications (6.2%). There was no occurrence of bleeding or skin infection while using this technique. CONCLUSIONS PRG with the co-axial angioplasty-balloon technique is a safe and effective technique for gastrostomy placement.
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Affiliation(s)
- Emily C Bendel
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Michael A McKusick
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chad J Fleming
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jeremy L Friese
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David A Woodrum
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Andrew H Stockland
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sanjay Misra
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Vascular and Interventional Radiology Translational Laboratory, Mayo Clinic, Rochester, MN, USA
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13
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Milovanovic L, Kennedy SA, Chrea B, Midia M. Safety and Short-Term Complication Rates Using Single-Puncture T-Fastener Gastropexy. J Vasc Interv Radiol 2016; 27:898-904. [PMID: 27134109 DOI: 10.1016/j.jvir.2016.02.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To report a single operator's experience using a modified single-puncture gastrostomy technique deploying up to three nonabsorbable gastropexy anchors. MATERIALS AND METHODS A retrospective review of 69 consecutive patients undergoing gastrostomy, gastrojejunostomy, or jejunostomy tube insertion between March 2012 and January 2014 was performed. Technical success and 30-day local, major, and minor complication rates were assessed according to the Society of Interventional Radiology (SIR) Standards of Practice for Gastrointestinal Access. Procedure time was also recorded. RESULTS Primary technical success of the procedure was 98.6% (68/69). In one patient, the procedure was aborted because the stomach could not be safely accessed. Major complications occurred in one of 69 (1.4%) patients, minor complications occurred in 10 of 69 (13%) patients, and local complications occurred in three of 69 (4.3%) patients. Local complications consisted of redness and mild tenderness at the enteric access site. Mean procedure time was 5 minutes (range, 3.1-36 min). CONCLUSIONS Single-puncture, multianchor gastrostomy is a feasible technique for radiologically guided enteric access tube insertion with technical success and complication rates similar to conventional gastrostomy techniques. This technique could be considered when expeditious performance of a procedure is required.
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Affiliation(s)
- Lazar Milovanovic
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, Ontario L7P4V9, Canada
| | - Sean A Kennedy
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, Ontario L7P4V9, Canada
| | - Bopha Chrea
- Department of Orthopedic Surgery, University of Washington, Seattle, Washington
| | - Mehran Midia
- Department of Diagnostic Imaging, McMaster University, 1200 Main Street West, Hamilton, Ontario L7P4V9, Canada.
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14
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Culp WTN, Balsa IM, Kim SY, Glaiberman CB, Grimes M, Mayhew PD, Johnson EG, Palm CA, Garcia TC, Kass PH. Description and Biomechanical Comparison of a Percutaneous Radiologic Gastropexy Technique in a Canine Cadaver Model. Vet Surg 2016; 45:456-63. [PMID: 27087643 DOI: 10.1111/vsu.12475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 10/04/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a novel percutaneous radiologic gastropexy (PRG) technique in a canine model and to biomechanically compare this technique to open incisional gastropexy (OIG) and laparoscopic-assisted incisional gastropexy (LAG). STUDY DESIGN Randomized ex vivo biomechanical study. ANIMALS Canine cadavers. METHODS Fifteen cadavers were randomized to 1 of 3 surgical interventions: OIG, LAG, and PRG. For the PRG procedure, the stomach was distended with air, and a preloaded T-fastener device was utilized to attach the stomach to the body wall with fluoroscopic-guidance. The procedural times of the 3 techniques were recorded. After completion of the procedure, the stomach and body wall overlying the stomach wall were harvested and the maximum tensile strength of the gastropexies was determined. RESULTS The maximal tensile strength was not significantly different between groups. The total procedural time for the PRG procedure (5 minutes) was significantly shorter than both OIG (28 minutes) and LAG (20 minutes) procedures. CONCLUSION The PRG technique described in this study demonstrated a similar maximal tensile strength to commonly employed gastropexy techniques (OIG and LAG) in an acute canine model. Additionally, the PRG procedure was significantly faster to perform. The clinical relevance of this technique will be determined by further study to assess the applicability and efficacy of this procedure in clinical patients by determining the likelihood of adhesion development and the ability of the adhesion to prevent gastric volvulus.
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Affiliation(s)
- William T N Culp
- Department of Surgical and Radiological Sciences, Davis, California
| | - Ingrid M Balsa
- Department of Surgical and Radiological Sciences, Davis, California
| | - Sun Y Kim
- Department of Surgical and Radiological Sciences, Davis, California
| | | | - Millie Grimes
- Department of Surgical and Radiological Sciences, Davis, California
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, Davis, California
| | - Eric G Johnson
- Department of Surgical and Radiological Sciences, Davis, California
| | - Carrie A Palm
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Tanya C Garcia
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, California
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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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Richioud B, Louazon T, Beji H, Bertrand A, Roux P, Kalenderian AC, Cuinet M, Pilleul F, Marec-Bérard P. De novo radiologic placement of button gastrostomy: a feasibility study in children with cancer. Pediatr Radiol 2015. [PMID: 26209960 DOI: 10.1007/s00247-015-3426-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment. OBJECTIVE To assess the safety and effectiveness of such treatment at a single center. MATERIALS AND METHODS We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months. RESULTS Eleven gastrostomies were performed in 11 children and young adults (3-20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects -- local leakage and granulation tissue formation -- both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight. CONCLUSION The procedure and devices were well tolerated and mostly effective in our cohort.
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Affiliation(s)
- Bertrand Richioud
- Department of Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France.
| | - Typhaine Louazon
- Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Hedi Beji
- Department of Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Amandine Bertrand
- Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Pascale Roux
- Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | | | - Marie Cuinet
- Department of Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Frank Pilleul
- Department of Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Perrine Marec-Bérard
- Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
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Huang SY, Engstrom BI, Lungren MP, Kim CY. Management of dysfunctional catheters and tubes inserted by interventional radiology. Semin Intervent Radiol 2015; 32:67-77. [PMID: 26038615 DOI: 10.1055/s-0035-1549371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Minimally invasive percutaneous interventions are often used for enteral nutrition, biliary and urinary diversion, intra-abdominal fluid collection drainage, and central venous access. In most cases, radiologic and endoscopic placement of catheters and tubes has replaced the comparable surgical alternative. As experience with catheters and tubes grows, it becomes increasingly evident that the interventional radiologist needs to be an expert not only on device placement but also on device management. Tube dysfunction represents the most common complication requiring repeat intervention, which can be distressing for patients and other health care professionals. This manuscript addresses the etiologies and solutions to leaking and obstructed feeding tubes, percutaneous biliary drains, percutaneous catheter nephrostomies, and drainage catheters, including abscess drains. In addition, we will address the obstructed central venous catheter.
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Affiliation(s)
- Steven Y Huang
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Bjorn I Engstrom
- Division of Interventional Radiology, Consulting Radiologists LTD, Minneapolis, Minnesota
| | - Matthew P Lungren
- Department of Radiology, Stanford University Medical Center, Palo Alto, California
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
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18
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Retrograde gastrojejunostomy tube migration. Case Rep Emerg Med 2014; 2014:738506. [PMID: 25614839 PMCID: PMC4295129 DOI: 10.1155/2014/738506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/17/2014] [Accepted: 12/03/2014] [Indexed: 01/30/2023] Open
Abstract
Percutaneous enteral feeding tubes are placed about 250,000 times each year in the United States. Although they are relatively safe, their placement may be complicated by perforation, infection, bleeding, vomiting, dislodgment, and obstruction. There have been numerous reports of antegrade migration of gastrojejunostomy (G-J) tubes. We report a case of G-J tube regurgitation following protracted vomiting and discuss the management of this very rare entity.
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Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: Techniques, problems and solutions. World J Gastroenterol 2014; 20:8505-8524. [PMID: 25024606 PMCID: PMC4093701 DOI: 10.3748/wjg.v20.i26.8505] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/10/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open
Abstract
Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.
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20
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Park JH, Shin JH, Ko HK, Kim JH, Song HY, Kim SH. Percutaneous radiologic gastrostomy using the one-anchor technique in patients after partial gastrectomy. Korean J Radiol 2014; 15:488-93. [PMID: 25053909 PMCID: PMC4105812 DOI: 10.3348/kjr.2014.15.4.488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/03/2014] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. Materials and Methods Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. Results Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). Conclusion Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.
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Affiliation(s)
- Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Heung Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Soo Hwan Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Sydnor RH, Schriber SM, Kim CY. T-fastener migration after percutaneous gastropexy for transgastric enteral tube insertion. Gut Liver 2014; 8:495-9. [PMID: 25228973 PMCID: PMC4164244 DOI: 10.5009/gnl13204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 01/25/2023] Open
Abstract
Background/Aims To determine the prevalence and time-course of t-fastener migration after gastropexy deployment. Methods We reviewed our procedural database for all percutaneous gastrostomy and gastrojejunostomy tube insertions performed over a 14-month period using a widely accepted t-fastener kit for gastropexy (Kimberly-Clark). Of 201 patients, 71 (41 males, 30 females; mean age, 56 years) underwent subsequent abdominal computed tomography (CT) imaging. The location and associated findings of each t-fastener were retrospectively recorded for each CT scan performed after the tube insertion. Results A total of 153 t-fasteners were deployed during 71 procedures with subsequent CT follow-up. In the short term (within 4 weeks after deployment), 5.1% of the t-fasteners had detached and were no longer present; 59.5% were intraluminal or within the gastric wall; and 35.5% were within the anterior abdominal wall musculature or subcutaneous. In the long term (>3 months), 48.6% of the t-fasteners had detached and were no longer present, 25.0% were intraluminal or within the gastric wall, and 26.4% were within the anterior abdominal wall musculature or subcutaneous. No t-fastener-related complications, such as abscesses, fluid collections, or fistulae, were identified. Conclusions Following gastropexy for percutaneous transgastric feeding tube placement, t-fastener migration into the abdominal wall frequently occurred soon after the tube insertion. Therefore, recent t-fastener deployment does not guarantee an intact gastropexy.
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Affiliation(s)
- Ryan H Sydnor
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC, USA
| | - Stacey M Schriber
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC, USA
| | - Charles Yoon Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC, USA
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22
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Prospective Evaluation of Absorbable Gastropexy Anchor Indwelling Time in 33 Patients. J Vasc Interv Radiol 2013; 24:1377-80. [DOI: 10.1016/j.jvir.2013.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/05/2013] [Accepted: 04/06/2013] [Indexed: 01/25/2023] Open
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Narayanam S, de Oliveira V, Krishnamurthy G, Bekhit E, Sertic M, Cheng HL, Connolly BL. Fate, complications and MRI implications of retention anchor suture placed during gastrostomy in children. Pediatr Radiol 2013; 43:1009-16. [PMID: 23417230 DOI: 10.1007/s00247-013-2627-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 11/15/2012] [Accepted: 11/27/2012] [Indexed: 01/25/2023]
Abstract
Retrograde radiologic gastrostomy is one of several techniques used for placing a gastrostomy and is a common technique used in children. The use of a retention anchor suture (RAS) is an important component of this procedure. This pictorial essay explores the normal course and passage of the RAS, as well as abnormal migration, various complications and the implications of the RAS with regard to MRI safety.
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Affiliation(s)
- Surendra Narayanam
- Diagnostic Imaging, Division of Image Guided Therapy, The Hospital for Sick Children, 555 University Ave, Toronto, Canada, M5G 1X8.
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25
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Stayner JL, Bhatnagar A, McGinn AN, Fang JC. Feeding tube placement: errors and complications. Nutr Clin Pract 2012; 27:738-48. [PMID: 23064019 DOI: 10.1177/0884533612462239] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Feeding tube placement for enteral nutrition (EN) support is widely used in both critically ill and stable chronically ill patients who are unable to meet their nutrition needs orally. Nasal or oral feeding tubes can be performed blindly at the bedside or with fluoroscopic or endoscopic guidance into the stomach or small bowel. Percutaneous feeding tubes are used when EN support is required for longer periods (>4-6 weeks) and are most commonly placed endoscopically or radiographically. Although generally safe and effective, there is a wide spectrum of known complications associated with feeding tube placement. Errors made at the time of feeding tube placement can result in a number of these procedural and postprocedural complications. In many cases, a single error at the time of placement can result in numerous complications. A thorough knowledge of these errors and avoiding them in practice will decrease iatrogenic complications in a vulnerable population. In addition, early recognition and management of complications will further minimize morbidity and even mortality in enteral feeding tube placement. This article reviews the common errors leading to complications of enteral feeding tube placement and their prevention and management.
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Affiliation(s)
- James L Stayner
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah 84132, USA
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Desport JC, Mabrouk T, Bouillet P, Perna A, Preux PM, Couratier P. Complications and survival following radiologically and endoscopically-guided gastrostomy in patients with amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/14660820410021258a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sista AK, Hwang GL, Hovsepian DM, Sze DY, Kuo WT, Kothary N, Louie JD, Yamada K, Hong R, Dhanani R, Brinton TJ, Krummel TM, Makower J, Yock PG, Hofmann LV. Applying a structured innovation process to interventional radiology: a single-center experience. J Vasc Interv Radiol 2012; 23:488-94. [PMID: 22464713 DOI: 10.1016/j.jvir.2011.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/17/2011] [Accepted: 12/24/2011] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the feasibility and efficacy of applying an established innovation process to an active academic interventional radiology (IR) practice. MATERIALS AND METHODS The Stanford Biodesign Medical Technology Innovation Process was used as the innovation template. Over a 4-month period, seven IR faculty and four IR fellow physicians recorded observations. These observations were converted into need statements. One particular need relating to gastrostomy tubes was diligently screened and was the subject of a single formal brainstorming session. RESULTS Investigators collected 82 observations, 34 by faculty and 48 by fellows. The categories that generated the most observations were enteral feeding (n = 9, 11%), biopsy (n = 8, 10%), chest tubes (n = 6, 7%), chemoembolization and radioembolization (n = 6, 7%), and biliary interventions (n = 5, 6%). The output from the screening on the gastrostomy tube need was a specification sheet that served as a guidance document for the subsequent brainstorming session. The brainstorming session produced 10 concepts under three separate categories. CONCLUSIONS This formalized innovation process generated numerous observations and ultimately 10 concepts to potentially to solve a significant clinical need, suggesting that a structured process can help guide an IR practice interested in medical innovation.
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Affiliation(s)
- Akhilesh K Sista
- Interventional Radiology, Weill Cornell Medical College, 525 East 68th Street, P-514, New York, NY 10065, USA.
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Seo N, Shin JH, Ko GY, Yoon HK, Gwon DI, Kim JH, Sung KB. Incidence and management of bleeding complications following percutaneous radiologic gastrostomy. Korean J Radiol 2012; 13:174-81. [PMID: 22438684 PMCID: PMC3303900 DOI: 10.3348/kjr.2012.13.2.174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 09/20/2011] [Indexed: 12/31/2022] Open
Abstract
Objective Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). Materials and Methods We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. Results The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. Conclusion We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.
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Affiliation(s)
- Nieun Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
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Stoneham G, Burbridge B, Pinilla J, Gourgaris A, Astrope V, Gordon H. Pneumoperitoneum post-fluoroscopic percutaneous gastrojejunostomy insertion: computed tomography and clinical evaluation. Can Assoc Radiol J 2012; 63:S33-6. [PMID: 22277803 DOI: 10.1016/j.carj.2011.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/13/2011] [Accepted: 04/14/2011] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION To assess the incidence and clinical significance of pneumoperitoneum after radiologic percutaneous gastrojejunostomy (PGJ) tube insertion. METHODS Sixteen subjects were prospectively assessed after imaging-guided PGJ tube insertion to discern the incidence of pneumoperitoneum related to specific clinical signs and symptoms. Computed tomography of the abdomen and the pelvis was performed immediately after PGJ insertion. A clinical evaluation, including history, general and abdominal physical examination, temperature, complete blood cell count, abdominal pain, and abdominal tension, was performed on days 1 and 3, and at the discretion of the nutritional support team on day 7 after PGJ insertion. RESULTS Fifteen of the 16 subjects demonstrated imaging findings of pneumoperitoneum after the PGJ-tube insertion. Only a small amount of pneumoperitoneum was demonstrated in 10 of the subjects, whereas a large volume of gas was detected in 2 of the subjects. The only altered clinical findings encountered were increased white blood cell count and fever. These abnormal clinical data were most frequently seen immediately after feeding-tube placement. DISCUSSION Pneumoperitoneum was a common finding after PGJ-tube placement in our study population. There were no statistically significant abnormal clinical parameters, in the presence or absence of pneumoperitoneum, for any of the subjects after PGJ-tube insertion. Conservative management of pneumoperitoneum after PGJ is warranted.
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Affiliation(s)
- Grant Stoneham
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Heberlein WE, Goodwin WJ, Wood CE, Yousaf M, Culp WC. Gastrostomy Tube Placement Without Nasogastric Tube: A Retrospective Evaluation in 85 Patients. Cardiovasc Intervent Radiol 2011; 35:1433-8. [DOI: 10.1007/s00270-011-0321-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/12/2011] [Indexed: 10/14/2022]
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Hassan SF, Pimpalwar AP. Modified laparoendoscopic gastrostomy tube (LEGT) placement. Pediatr Surg Int 2011; 27:1249-54. [PMID: 21947136 DOI: 10.1007/s00383-011-2977-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to report the outcomes of our modified LEGT technique. METHODS Charts of 26 children who underwent modified LEGT technique between May 2008 and February 2010 were retrospectively reviewed. Their age ranged from 7 days to 16 years. Under general anesthesia, a gastroscope was placed in the stomach and laparoscopic visualization was obtained through a 5 mm umbilical port. Using laparoscopic and gastroscopic visualization, four 2'0' PDS 'T'-Fasteners were placed around a proposed gastrostomy site in the stomach. These sutures were pulled externally and tied subcutaneously so that nothing was visible outside. The gastrostomy button was then placed in the center of these four sutures at the proposed gastrostomy button site. Once the gastrostomy balloon was inflated, the four sutures were pulled taut and tied subcutaneously to pexy the stomach to the abdominal wall. Visualization with the gastroscope and laparoscope ensured proper gastrostomy button placement. RESULTS At a median follow-up of 9 months (range 10 days-2 years), none of the patients had major complications and only five had minor gastrostomy site infection which completely resolved after antibiotic therapy. CONCLUSIONS LEGT is a safe and effective technique for placement of primary G buttons/tubes in children. The laparoscopic visualization of the LEGT avoids accidental gastro-enteric fistula formation and allows primary placement of the gastrostomy button without need for subsequent procedures. LEGT ensures that the G-button is placed within the gastric lumen. Additionally, the four 'T'-Fastener technique gives optimal fixation of the stomach to the abdominal wall, avoids accidental disruption of sutures as they are placed subcutaneously and has no need for suture removal at a post-operative visit as in other techniques. Since there are no other ports used except the umbilicus this technique provides excellent cosmetic results.
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Affiliation(s)
- Saif F Hassan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA
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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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Percutaneous Push-Through Gastrostomy by Applying a CT-Guided Gastropexy. J Vasc Interv Radiol 2011; 22:1149-52. [DOI: 10.1016/j.jvir.2011.02.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 02/19/2011] [Accepted: 02/25/2011] [Indexed: 11/22/2022] 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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Abstract
Gastrostomy allows enteral nutrition to continue in patients who are unable to meet their caloric requirements orally. Though the indications for gastrostomy placement are varied, dysphagia secondary to a neurological condition is the most common. These catheters were initially placed surgically, but percutaneous endoscopic placement is now the routine in most centers. Interventional radiologists have been performing this procedure under fluoroscopic guidance for several years with encouraging results. Percutaneous radiological gastrostomy is reported to have a success rate comparable to that of the endoscopic method, with lower morbidity and mortality rates. A further benefit is that it may be performed in patients for whom the endoscopic method would be difficult or dangerous, such as those with head and neck malignancies. One of the main factors currently limiting the use of this procedure is the shortage of interventional radiology facilities and specialists.This article describes a technique for routine percutaneous radiological gastrostomy catheter placement and procedural variations for difficult cases. Indications and contraindications will be discussed, as will complication rates and how these compare with the traditional methods of gastrostomy tube placement.
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Affiliation(s)
- Stuart M Lyon
- Interventional Radiologist, Alfred Hospital, Melbourne, Australia
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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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Kulik DM, Scolnik D. An unexpected cause of emesis. J Emerg Med 2011; 43:702-3. [PMID: 21605955 DOI: 10.1016/j.jemermed.2010.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 11/03/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Dina M Kulik
- Department of Pediatrics, University of Toronto, the Hospital for Sick Children, Toronto, Ontario, Canada
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Kulvatunyou N, Joseph B, Tang A, O'Keeffe T, Wynne JL, Friese RS, Latifi R, Rhee P. Gut access in critically ill and injured patients: Where have we gone thus far? Eur Surg 2011. [DOI: 10.1007/s10353-011-0590-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
BACKGROUND/AIMS Interventional radiologists have played a main role in the technical evolution of gastrostomy, from the first surgical/endoscopical approaches to percutaneous interventional procedures. This study evaluated the results obtained in a 12-year series. METHODS During the period December 1996 to December 2008, 254 new consecutive gastrostomies and 275 replacement procedures were performed in selected patients. All of the cases were treated by a T-fastener gastropexy and tube placement. The procedures were assessed by analyzing indications, patient selection, duration of the procedures, and mortality. RESULTS All 254 first gastrostomies were successful; replacement procedures were also successfully performed. One (0.2%) patient with severe neurologic disorders died after the procedure without signs of procedure-related complications, and seven (1.3%) major complications occurred (four duodenal lesions with peritoneal leakage, two gastric bleedings, and one gastric lesion). Minor complications were easily managed; three tube ruptures were resolved. CONCLUSIONS This long-term series and follow-up showed that a group of interventional radiologist can effectively provide gastrostomy placement and long-term tube management. Percutaneous gastrostomy is less invasive than other approaches and it satisfies the needs even of high-risk patients.
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Blondet A, Lebigot J, Nicolas G, Boursier J, Person B, Laccoureye L, Aubé C. Radiologic versus endoscopic placement of percutaneous gastrostomy in amyotrophic lateral sclerosis: multivariate analysis of tolerance, efficacy, and survival. J Vasc Interv Radiol 2010; 21:527-33. [PMID: 20172742 DOI: 10.1016/j.jvir.2009.11.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 11/06/2009] [Accepted: 11/30/2009] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare percutaneous radiologic gastrostomy (PRG) and percutaneous endoscopic gastrostomy (PEG) in terms of tolerance, efficacy, and survival in patients with amyotrophic lateral sclerosis (ALS). MATERIALS AND METHODS Forty patients with ALS (17 men; mean age, 66.1 years; range, 39-83 y) underwent 21 PEG and 22 PRG attempts (including three unsuccessful PEG attempts) from 1999 to 2005. To assess tolerance and efficacy, a successful and well tolerated placement was defined as any successful placement with no major or minor local complications or pain requiring opioid analgesic agents. Univariate analysis was performed for all recorded parameters, followed by multivariate analysis for successful and well tolerated placement, 6-month mortality rate, and survival. RESULTS General success rates were 85.7% for PEG and 100% for PRG. Pain was more frequent in PRGs (81.8% vs 52.4%; P = .05). Successful and well tolerated placement was seen in 81.8% of PRGs and 57.1% of PEGs (P = 0.1). Advanced age (P = .02) and PRG (P = .07) were predictive of successful and well tolerated placement. The interval from diagnosis to placement (P = .001) and ability to perform spirometry (P = .002) were predictive of survival. Oximetry measurements (P = .007) and interval from diagnosis to placement (P = .02) were predictive of mortality at 6 months. CONCLUSIONS PRG is more efficacious and better tolerated than PEG, essentially because it avoids the respiratory decompensation that may occur in PEG. Therefore, PRG should be preferred in cases of ALS. Survival is linked to ALS evolution and not to the choice of PRG or PEG placement.
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Affiliation(s)
- Alexandre Blondet
- Department of Radiology, Centre Hospitalier Universitaire Angers, 4, rue Larrey, Angers Cedex 09, F-49933 France
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Mushroom-cage gastrostomy tube placement in patients with amyotrophic lateral sclerosis: a 5-year experience in 104 patients in a single institution. Eur Radiol 2009; 19:1763-71. [PMID: 19190913 DOI: 10.1007/s00330-009-1307-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 12/27/2008] [Indexed: 12/11/2022]
Abstract
To review our experience of placement of a mushroom-cage gastrostomy tube (Entristar, Tyco Healthcare, Mansfield, MA), using radiological guidance, in patients with amyotrophic lateral sclerosis (ALS). All procedures were performed under local anaesthesia without sedation. Complications were recorded as peri-procedural, early (<24 h), late (>24 h), major or minor. Deaths were recorded as related to the underlying ALS or secondary to radiological-inserted gastrostomy (RIG) placement. Replacement RIG tube rate was recorded. Over a 5-year period RIG tubes were placed in 104 patients with ALS (male n = 52, female n = 52), with a median age of 62 years (range 34-86 years). All procedures were technically successful. Of the RIG procedures, 21/104 (20.2%) were performed with respiratory support. The 30-day mortality rate was 7/104 (6.7%); no patient died as a result of the procedure. There were 23/104 (22.1%) complications overall; 20/104 (19.2%) were minor and 3/104 (2.9%) major, requiring surgery (n = 2) and radiological-guided abscess drainage (n = 1). A median interval between replacement RIG procedures in 20/104 (19.2%) patients was 141.5 days (range 43-537 days). A mushroom-cage RIG tube may be safely and effectively inserted in a 'one-step' radiological procedure and may replace endoscopic-inserted gastrostomy tubes in the nutritional management of ALS.
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Shin JH, Song HY, Kim TH, Kim KR, Choi KE, Kim JH. Percutaneous radiologic gastrostomy: a modified Chiba-needle puncture technique with single gastropexy. ACTA ACUST UNITED AC 2009; 35:189-94. [DOI: 10.1007/s00261-008-9496-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 12/09/2008] [Indexed: 10/21/2022]
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The One-Anchor Technique of Gastropexy for Percutaneous Radiologic Gastrostomy: Results of 248 Consecutive Procedures. J Vasc Interv Radiol 2008; 19:1048-53. [PMID: 18589319 DOI: 10.1016/j.jvir.2008.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 03/20/2008] [Accepted: 03/20/2008] [Indexed: 01/25/2023] Open
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Shin KH, Shin JH, Song HY, Yang ZQ, Kim JH, Kim KR. Primary and conversion percutaneous gastrojejunostomy under fluoroscopic guidance: 10 years of experience. Clin Imaging 2008; 32:274-9. [DOI: 10.1016/j.clinimag.2007.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 10/20/2007] [Indexed: 11/26/2022]
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Tam A, Wagner-Bartak N, Wallace M, Murthy R. Liver abscess after inadvertent transhepatic transgression during percutaneous fluoroscopy-guided gastrostomy. Clin Radiol 2008; 63:731-5. [DOI: 10.1016/j.crad.2007.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 09/04/2007] [Accepted: 09/14/2007] [Indexed: 11/30/2022]
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Stability of balloon-retention gastrostomy tubes with different concentrations of contrast material: in vitro study. Cardiovasc Intervent Radiol 2008; 32:127-31. [PMID: 18446408 DOI: 10.1007/s00270-008-9355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 04/05/2008] [Accepted: 04/10/2008] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to determine the performance of two balloon-retention-type gastrostomy tubes when the balloons are inflated with two types of contrast materials at different concentrations. Two commonly used balloon-retention-type tubes (MIC and Tri-Funnel) were inflated to the manufacturer's recommended volumes (4 and 20 cm(3), respectively) with normal saline or normal saline plus different concentrations of contrast material. Five tubes of each brand were inflated with normal saline and 0%, 25%, 50%, 75%, and 100% contrast material dilutions, using either nonionic hyperosmolar contrast, or nonionic iso-osmolar contrast. The tubes were submerged in a glass basin containing a solution with a pH of 4. Every week the tubes were visually inspected to determine the integrity of the balloons, and the diameter of the balloons was measured with a caliper. The tests were repeated every week for a total of 12 weeks. The MIC balloons deflated slightly faster over time than the Tri-Funnel balloons. The Tri-Funnel balloons remained relatively stable over the study period for the different concentrations of contrast materials. The deflation rates of the MIC balloons were proportionally related to the concentration of saline and inversely related to the concentration of the contrast material. At high contrast material concentrations, solidification of the balloons was observed. In conclusion, this in vitro study confirms that the use of diluted amounts of nonionic contrast materials is safe for inflating the balloons of two types of balloon-retention feeding tubes. High concentrations of contrast could result in solidification of the balloons and should be avoided.
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Cantwell CP, Perumpillichira JJ, Maher MM, Hahn PF, Arellano R, Gervais DA, Mueller PR. Antibiotic Prophylaxis for Percutaneous Radiologic Gastrostomy and Gastrojejunostomy Insertion in Outpatients with Head and Neck Cancer. J Vasc Interv Radiol 2008; 19:571-5. [DOI: 10.1016/j.jvir.2007.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 11/13/2007] [Accepted: 11/14/2007] [Indexed: 01/25/2023] Open
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Feasibility and safety of infracolic fluoroscopically guided percutaneous radiologic gastrostomy. J Vasc Interv Radiol 2008; 19:129-32. [PMID: 18192478 DOI: 10.1016/j.jvir.2007.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We study the feasibility and safety of infracolic fluoroscopically guided percutaneous gastrostomy when patient anatomy prevents conventional supracolic puncture. From September 2004 to April 2007, 508 gastrostomy and gastrojejunostomy catheters were inserted in a single institution, and in six patients, the position of the transverse colon prevented conventional supracolic puncture. All were male, with a mean age of 57 years. Four patients had head and neck cancer and two had neurologic conditions. With fluoroscopic guidance, a 14-F gastrostomy tube was inserted with T-fastener gastropexy caudal to the colon. The medical records of patients treated with this technique were reviewed for demographics, indication, technique, complications, function of gastrostomy, timing of removal of the gastrostomy, and subsequent hospital admissions. All procedures were technically successful and there was no procedure-related morbidity or mortality. The mean follow-up was 16 months (range, 7-25 months) and the mean duration of therapy was 7 months. Five patients had their gastrostomy removed after clinical improvement and one of these patients had a gastrostomy reinserted cephalic to the colon after recurrence of head and neck cancer. Two patients died of disease progression and one still had the gastrostomy in position. No patient was subsequently admitted for a complication of the technique or catheter malfunction. In conclusion, infracolic percutaneous radiologic gastrostomy with gastropexy is feasible in patients without an access route cephalic to the transverse colon.
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Mangray H, Latchmanan NP, Govindasamy V, Ghimenton F. Grey’s Ghimenton Gastropexy: An Anatomic Make-Up for Management of Gastric Volvulus. J Am Coll Surg 2008; 206:195-8. [DOI: 10.1016/j.jamcollsurg.2007.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 05/02/2007] [Accepted: 05/14/2007] [Indexed: 11/29/2022]
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