Radiologic gastrojejunostomy and percutaneous endoscopic gastrostomy: a prospective, randomized comparison

PURPOSE: To compare the efficacy of radiologic guided placement of percutaneous gastrojejunostomy (PGJ) and percutaneous endoscopic gastrostomy (PEG). MATERIALS AND METHODS: Patients were randomized to PGJ (n = 66) or PEG (n = 69). Indications for gastrostomy were need for prolonged enteral nutrition (97%) or gastrointestinal decompression (3%), with etiologies of neurologic impairment (81%), head and neck neoplasm (12%), bowel obstruction (3%), or other (4%). Mean follow-up was 202 days and 30-day follow-up was obtained for 85% of patients. RESULTS: PEG was successful in 63 of 69 (91%) patients, while PGJ established access in all of 66 attempts (100%) (P = .014). Average procedural time was 53 minutes for PGJ and 24 minutes for PEG (P = .001). At 30-day follow-up, there were 33 and 45 complications in the PGJ and PEG groups, respectively. This difference was due to the greater incidence of pneumonia in the PEG group (P = .013). Long-term tube-related complications occurred with 17 PGJs and four PEGs (P = .007). The PGJ cost more than PEG, but this advantage was offset by the cost of complications. CONCLUSION: PGJ had higher success rate and fewer complications, due to a lower incidence of pneumonia. PEG took less time to perform, cost less, and required less tube maintenance.     

Percutaneous radiologic gastrostomy with and without T-fastener gastropexy: a randomized comparison study

Purpose: T-fastener gastropexy is used by many interventional radiologists during percutaneous radiologic gastrostomy (PRG) placement. Whether gastropexy is a prerequisite to safe gastrostomy placement is uncertain. We evaluated the use of T-fastener gastropexy versus no gastropexy for PRG in a prospective, randomized study. Methods: Of 90 consecutive patients referred for PRG, 48 were randomly selected to receive T-fastener gastropexy (M:F, 35:13; mean age 62 years, range 20–90 years) and 42 to receive no gastropexy (M:F, 31:11; mean age 63 years, range 40–90 years). Technical difficulties and fluoroscopy times were recorded for both groups and all patients were followed up for postprocedural complications. T-fasteners were removed between 3 and 7 days after gastrostomy insertion. Results: A major complication was encountered in four patients from the non-gastropexy group (10%). In these cases the guidewire and dilator "flipped" out of the stomach into the peritoneal cavity. This resulted in misplacement of the gastrostomy tube in the peritoneal cavity in two of the patients. This was discovered at the end of the procedure when a test injection of contrast medium was performed. In three of these patients the procedure was rescued and completed radiologically. One patient underwent endoscopic gastrostomy placement. Five of 48 patients (10%) who received a gastropexy had pain associated with the T-fastener sites. Six patients (13%) had skin excoriation at the T-fastener sites. No skin complications were seen in the non-gastropexy group. No statistical difference in fluoroscopy time was observed between the two groups. Conclusion: Our experience of PRG without T-fastener gastropexy involved a 10% incidence of serious technical complications. We suggest that T-fastener gastropexy should be performed routinely for all PRG procedures. T-fastener gastropexy has an associated minor complication of pain and skin excoriation at the gastrostomy site which resolves on removing the T-fasteners.     

Stomal metastases complicating percutaneous endoscopic gastrostomy: CT findings and the argument for radiologic tube placement

OBJECTIVE: This article describes the CT appearance of metastatic implantation at the percutaneous endoscopic gastrostomy (PEG) tract in patients with malignancy of the upper aerodigestive tract. Cumulative data from previous case reports are also considered for insight into causes of metastasis and the implications for gastrostomy placement in these patients. CONCLUSION: CT showed lobulated soft tissue involving the entire abdominal wall PEG tract in all proven cases. CT is an effective method for evaluation because the tumor burden lies predominately in the abdominal wall and not at the entry or exit site. The stomal implant is often the only site of metastatic disease at presentation. In general, CT findings of mildly increased soft tissue along the PEG tract are nonspecific, but a lobulated mass is highly suspicious for tumor implantation, especially if the one-sided thickness exceeds 1 cm. The preponderance of evidence from the existing literature points to direct tumor implantation during endoscopic placement as the likely cause (rather than hematogenous spread). This conclusion would support the alternative of radiologic tube placement in these patients.     

Percutaneous radiologic gastrostomy with a simplified gastropexy technique under ultrasonographic and fluoroscopic guidance: experience in 154 patients

Purpose: To evaluate the effectiveness and safety of percutaneous radiologic gastrostomy (PRG) under ultrasonographic (US) and fluoroscopic guidance using a simplified gastropexy technique.

Material and Methods: One hundred and fifty-four (154) patients (mean age 73, range 22-93 years) were referred for PRG. Indication for PRG was neurologic disease, head/neck cancer, and other disease in 73%, 15%, and 12%, respectively. Initially, the stomach was filled with 300-500 cm³ of tap water via a nasogastric tube. The fluid-filled stomach was punctured under US guidance. A guidewire and a single T-fastener were introduced. Under fluoroscopic guidance, the tract was dilated over the guidewire until a 16F dilator with a peel-away sheath could be introduced. During dilatation, the external suture string to the T-fastener was held tight to fixate the gastric wall. A 14F balloon-retained gastrostomy tube was introduced and inflated. The T-fastener was then released, and the gastrostomy tube was retracted gently to affix the gastric wall to the abdominal wall (tube gastropexy). Technical success was assured by aspiration of gastric fluid and fluoroscopically by injection of a water-soluble contrast medium.

Results: The primary technical success rate was 98%. At 30-day follow-up, 3.2% had major complications and 14% minor complications. Three patients (1.9%) died of complications related to the procedure. Thirteen cases (8%) of simple tube displacement without other complications occurred.

Conclusion: PRG guided by US and fluoroscopy is a relatively safe technique with a high success rate, provided the stomach can be properly distended with fluid. However, tube gastropexy alone does not seem to protect against early dislodgement.     

Percutaneous vertebroplasty: indications, contraindications, technique, and complications

Percutaneous vertebroplasty is emerging as one of the most promising new interventional procedures for relieving (or reducing) painful vertebra, with the injection of surgical polymethylmethacrylate or cement into vertebral bodies. This imaged-guided technique, originally used to treat vertebral hemangioma, has recently been extended to the treatment of metastases, osteoporotic compression fractures, and vertebral myeloma. It is increasingly being accepted as a main treatment of choice in the management of resistant back pain due to vertebral compression fractures, especially in the elderly individual who is not a candidate for surgery. In this article, we review indications, contraindications, technique, and complications of percutaneous vertebroplasty.     

Percutaneous gastrostomy and percutaneous gastrojejunostomy in children: antegrade approach

Twenty-five percutaneous gastrostomies and nine percutaneous gastrojejunostomies were performed in 24 children aged 4 months to 22 years. Indications for percutaneous gastrostomy included severe injury to the central nervous system (nine patients), malignancy (seven patients), failure to thrive (four patients), degenerative central nervous system disease (one patient), and miscellaneous conditions (three patients). All procedures were performed under local anesthesia and sedation. An antegrade approach is described for percutaneous gastrostomy and percutaneous gastrojejunostomy placement. No major complication occurred, and only three skin infections have been encountered. The children were evaluated and followed up by a nutritional support team. Early experience with percutaneous gastrostomy and percutaneous gastrojejunostomy in the pediatric population suggests that the technique is safe and applicable to children of all ages and sizes. In particular, the antegrade approach appears to be an acceptable solution for enteric alimentation.     

Percutaneous conversion of surgical gastrostomy to jejunostomy: indications and technique

Should a surgical gastrostomy prove to be inappropriate it can readily be converted to a jejunostomy using standard percutaneous techniques. We have used this technique in six patients with gastro-esophageal reflux, four with gastric perforation, two with gastric outlet obstruction, two with duodenal perforations, and two patients with gastrostomy breakdown. Technical success was achieved in all and clinical success in 15 of 16.     

Feasibility and safety of infracolic fluoroscopically guided percutaneous radiologic gastrostomy

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.     

经皮骨水泥椎间融合术与骨水泥椎间盘成形术治疗老年腰椎间盘突出症的疗效比较

目的 探讨经皮骨水泥椎间融合术(PCIF)治疗老年腰椎间盘突出症的初步临床价值,并与经皮骨水泥椎间盘成形术(PCD)作比较.方法 回顾性分析2013年1月至2019年11月37例老年腰椎间盘突出症的患者,其中29例采用PCIF治疗(A组),8例采用PCD治疗(B组).A组包括L3～4椎间盘节段4例、L4～5椎间盘节段2...     

Percutaneous gastrostomy with gastropexy: experience in 125 patients

We report our experience with radiologically guided percutaneous tube gastrostomy in 125 patients by using a gastropexy technique in which the anterior gastric wall is nonsurgically sutured to the anterior abdominal wall with percutaneously placed T-fasteners before catheter insertion. Short-term follow-up of up to 2 weeks was available in all patients. In 63 patients, long-term follow-up (greater than 4 weeks; average, 3.5 months; maximum, 1 year) was available. Catheter placement was successful in 124 (99%) of 125 patients, including three patients with anatomic changes after Bilroth II hemigastrectomy and two patients with failed endoscopic attempts. There were no deaths related to the procedure, and no patients required surgical intervention for complications attributable to the gastrostomy procedure. The 30-day mortality rate was 11% (n = 7). These deaths were due to cardiorespiratory arrest and were not attributable to the gastrostomy procedure. Major complications occurred in 1.6% (n = 1) and minor complications in 9.5% (n = 6). These results indicate that percutaneous gastrostomy with gastropexy is a safe and effective technique for placement of catheters in the stomach.     

Percutaneous radiofrequency ablation of renal tumors: technique, complications, and outcomes

PURPOSE: To report the safety, technical success, and effectiveness of percutaneous radiofrequency (RF) ablation for renal tumors. MATERIALS AND METHODS: The authors retrospectively reviewed the medical records and imaging studies of 29 consecutive patients (18 men, 11 women; mean age, 65 +/- 2.62 years) with 30 renal tumors (mean diameter, 3.5 +/- 0.24 cm) who underwent percutaneous RF ablation at their institution from September 2001 to March 2004. All procedures were performed with computed tomography guidance with general anesthesia, and all patients were admitted to the hospital for overnight observation. Technical success, complications, and their management were recorded. Technique effectiveness was assessed by imaging and clinical follow up. RESULTS: Overall, 88 overlapping ablations were performed (mean, 2.6 +/- 0.16 ablations per tumor per session) in 34 sessions. There were four major complications (12%). Three patients had gross hematuria and urinary obstruction, all were successfully treated. One patient had persistent anterior abdominal wall weakness. There were also two minor complications (6%) without significant clinical sequelae. One patient had gross hematuria which resolved spontaneously, another patient had transient paresthesia of the anterior abdominal wall. There were no significant changes in renal function after RF ablation. The intent of RF ablation was eradication of the primary tumor in 27 patients and treatment of gross hematuria in the other two. Technical success was achieved in all cases. Follow-up images were available for 26 patients. The primary tumor was completely ablated in 23 of 24 patients (96%) in whom eradication of the primary tumor was attempted (follow up period: mean, 10 months, median 7 months). The two patients treated for hematuria remained asymptomatic for 6 and 27 months each. CONCLUSION: Percutaneous RF ablation for renal tumors is safe and well tolerated. High technical success rates are expected. Early reports of the technique's effectiveness are promising.     

经皮内镜引导下、经皮影像学引导下施行胃造瘘术的比较研究

胃造瘘术,为各种病因所致的进口摄食障碍患者提供了良好的肠内营养通道.过去对于胃造瘘管的放置方式,有多种不同的尝试,包括传统外科手术,近20年来,通过内镜引导下或影像引导下放置胃造瘘管的操作技术发展迅速,上述2项操作与外科方式相比,手术创伤小,费用相对较低,并发症发生率低,明显优于外科手术,本总结上述2种胃造瘘方法在临床上的运用情况,从适应证、操作方法、并发症等方面进行比较性研究.     

The one-anchor technique of gastropexy for percutaneous radiologic gastrostomy: results of 248 consecutive procedures

PURPOSE: To evaluate the safety and efficacy of the one-anchor technique of gastropexy for percutaneous radiologic gastrostomy (PRG). MATERIALS AND METHODS: A total of 248 PRG procedures with the one-anchor technique were attempted in 242 consecutive patients between January 2000 and June 2006. For gastropexy, a single anchor was used and gastrostomy tube placement was performed through the same tract of the anchor with a 10-16-F Wills-Oglesby gastrostomy catheter. Technical success, complications, and anchor dislodgments were evaluated by means of review of imaging studies and patient medical records. RESULTS: Among 248 procedures, PRG with the one-anchor technique was performed successfully in 247 procedures, with one procedural failure (99.6% successful placement rate). Fourteen-day follow-up data were available for 216 patients (87%). There were 11 major complications (5.1%), including peritonitis (n = 5), bleeding (n = 4), infection requiring tube removal (n = 1), and gastrocolic fistula (n = 1); and 31 minor complications (14.4%), including tube malfunction (ie, dislodgment, occlusion, breakage; n = 26), oozing (n = 4), and infection (n = 1). There were 25 anchor dislodgments, including breakdown of the string of the anchor during the procedure (n = 5), early release of the anchor within 1 week (n = 9), migration into the peritoneal space (n = 8), and expulsion out of the body (n = 3). Four major complications and one failure were directly related to anchor dislodgment. CONCLUSIONS: PRG with the one-anchor technique is a feasible procedure. However, anchor dislodgments are relatively common, and these are related to major complications such as peritonitis and bleeding.     

Effect of percutaneous endoscopic gastrostomy on gastrointestinal motility: evaluation by gastric-emptying scintigraphy

PURPOSE: Firstly, to assess the effect of percutaneous endoscopic gastrostomy (PEG) tube placement on gastric emptying, gastrointestinal (GI) tract motility and the rate of gastroesophageal reflux (GER). Secondly, to confirm whether correlations exist between drug absorption behaviour and GI tract motility using the combination method of absorption function analysis with the motility study. METHODS: Subjects comprised 11 patients with neurological dysphagia. Gastric-emptying scintigraphy was performed both before PEG via nasogastric tube feeding and after PEG placement. After fasting for more than 8 h, each patient was administered 111 MBq of 99mTc-labelled diethylenetriaminepentaacetic acid (DTPA) with a 100 ml liquid meal via a nutrition tube. Dynamic imaging was performed immediately after administration of a radiolabelled liquid meal for a 1 h period and static imaging was performed after 1, 2, 3 and 6 h. Gastric emptying half-time (T50) was calculated in each patient, and GER ratio and GI transit rate were also evaluated. Simultaneously, we administered 10 mg of famotidine in six of the 11 patients and measured serum concentrations of famotidine at 0, 1, 2, 3 and 6 h. Using the time-concentration curve of famotidine, the maximum concentration of famotidine (Cmax) and area under the curve of famotidine (AUCf) were calculated for each patient. RESULTS: In seven of 11 patients, T50 changed after PEG placement, but not significantly. The GER ratio was significantly decreased and complicated pneumonia improved after PEG placement. GI transit rate for each GI segment was unchanged after PEG placement. Significant linear correlations were identified between T50 and both Cmax and AUCf. CONCLUSION: Gastric-emptying scintigraphy with Tc-DTPA was effective in the evaluation of GI transit before and after PEG, as well as in assessing GER. Motility and famotidine absorption were maintained after PEG placement. Significant linear correlations were found between T50 and both Cmax and AUCf. These findings suggest that drug absorption may have some relationship between T50. The result may be more reliable with a larger population.