Percutaneous gastrostomy and gastrojejunostomy

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.

Keywords: Gastrostomy; gastrojejunostomy; interventional radiology.

Figures

Figure 1

(A) Gastropexy needle and T-fastener. (B) Intragastric confirmation of needle position through air aspiration (arrow).

Figure 2

(A) External appearance of gastropexy; sutures are cut at skin level at 2 to 20 days. (B) Fluoroscopic appearance in the same patient demonstrating T-fasteners (arrows), nasogastric tube (arrowheads), and colon containing barium (white arrows).

Figure 3

Balloon-retained (A) gastrostomy tube (arrows) and (B) gastropexy (arrowheads) are shown, while intragastric position is confirmed with contrast (white arrow).

Figure 4

Immediate postprocedure fluoroscopic image of a percutaneous radiological gastrojejunostomy. The catheter tip is sited in the proximal jejunum (arrow). Note the gastropexy (white arrowheads) and retaining balloon (white arrow).