Percutaneous gastrostomy

Percutaneous gastrostomy was performed in 7 patients using standard interventional techniques. The procedure was successful in 6 patients but was terminated in the seventh patient because of pain. In 5 cases, feeding posed no difficulty; one patient had outlet obstruction, perhaps related to a duodenal ulcer. In one patient the catheter was removed following improvement. In 3 it continued to function until death, although in one case feeding became difficult shortly before death. The seventh patient is alive and tolerating catheter feedings well, even though catheterization was difficult because of ascites. Indications for percutaneous gastrostomy include neoplasms involving the digestive system proximal to the stomach, facial trauma and burns, debilitation, and distal enteric intubation in patients who cannot tolerate gastric feeding.     

Percutaneous gastrostomy: further experience

Percutaneous gastrostomy was performed in nine patients, bringing to 17 the total number of such procedures now performed in the authors' department. As a result of this additional experience, the authors have further refined the technique and have had the opportunity to follow a number of patients for extended periods. Percutaneous gastrostomy appears to be an effective alternative to surgical gastrostomy.     

Percutaneous radiologic gastrostomy

Gastrostomy is a preferred method of nutrition in patients with impaired ability to eat. Although surgical gastrostomy is a well-established method and has been widely performed in the last century, beginning with early 1980s, percutaneous gastrostomy techniques, either endoscopic or radiologic, has widely gained acceptance. As percutaneous methods have been shown to be an effective, safe, easy to perform and low-cost techniques with low morbidity and mortality rates, nowadays percutaneous gastrostomy is the first method of choice in need of nutrition in patients with functioning gut. In this article authors review the technique of percutaneous radiologic gastrostomy, as well as indications, contraindications, variations of technique, ethical considerations, controversies and comparison with surgical and endoscopic methods.     

Percutaneous gastrostomy]

Percutaneous gastrostomy was developed over the last years as an alternative method to surgical and endoscopic procedures, either for enteral feeding or for drainage of secretions or fluid collections communicating with the upper gastrointestinal (GI) tract. January 1990 through January 1992, 15 percutaneous gastrostomies and 2 percutaneous jejunostomies were performed at the Gastroenterologic Radiology Division of INT, Milan, Italy. The catheters were always inserted under local anesthesia, generally using special gastrostomy sets. Catheter insertion was possible in all the patients who underwent the procedure: in 12 cases gastrostomy allowed enteral feeding till the patients died and in 1 case the catheter is still working. In 2 cases the procedure was performed for drainage of gastroenteric secretions and the catheter was left in situ as a definitive palliation. In 1 patient the catheter was removed after draining a collection due to an anastomotic fistula. No major complications were observed in 17 procedures. In our experience, the indication according to which percutaneous gastrostomies and jejunostomies were performed for enteral feeding was always affected by the presence of a stenosis, in the upper GI tract. Other indications to the procedure, for enteral feeding, are functional swallowing disorders. Finally, it must be emphasized that when tight stenoses of the upper GI tract are present, percutaneous gastrostomy is the sole alternative to surgery.     

Percutaneous urolithotomy: the use of balloon catheters as an adjunct

Balloon catheters were used in three patients to assist in the removal of upper urinary tract calculi that resisted extraction by conventional means. Both angioplasty catheters and Foley catheters may be used to dislodge hard-to-reach calyceal calculi or ureteral calculi into more accessible locations, such as the renal pelvis or an ileal conduit.     

Percutaneous gastrostomy and gastro-jejunostomy

Percutaneous gastrostomy and gastro-jejunostomy are new techniques which may be used instead of surgical or endoscopic gastrostomy to feed patients with an intact small bowel. We have successfully performed 72 gastrostomies on 67 patients who had had unsuccessful procedures and required surgery. Two patients developed peritonitis when their catheter dislodged into the peritoneal space.     

Percutaneous radiological gastrostomy: single-puncture double-anchor technique

Purpose

We evaluated technical success, safety and effectiveness of percutaneous radiological gastrostomy (PRG) with a modified technique: single puncture and double anchor.

Materials and methods

From January 2008 to June 2011, 163 patients underwent PRG with a single-puncture double-anchor technique. The stomach was punctured with a 17-gauge Chiba needle, and gastropexy was performed by placing two anchors in the gastric lumen. Finally, a 12-F Wills-Oglesby percutaneous gastrostomy catheter was inserted. Technical success and complications at 30 days were evaluated on the basis of imaging and patients’ medical records.

Results

PRG was successfully completed in all 163 patients. Only a single puncture was required in all patients. The average PRG procedure time was 9 min. Three patients had major complications: haemorrhage (n=2) and pneumoperitoneum (n=1). Ten patients had minor complications: tube malfunction/breakage (n=9), and leakage through the insertion site (n=1). Two patients died 30 days after the procedure.

Conclusions

Single-puncture double-anchor PRG is a fast, safe and effective technique.     

Percutaneous gastrostomy for jejunal feeding

A simple percutaneous gastrostomy technique for jejunal feeding which requires no general anesthesia or gastroscopy is described. This may replace the feeding jejunostomy as a means of providing total enteral nutrition to patients with severe and disabling esophageal or gastric dysfunction.     

Percutaneous gastrostomy for enteral feeding

Over a period of 18 months, percutaneous nonendoscopic gastrostomy using the Seldinger technique was successfully performed in 32 adults for enteral feeding. There were no deaths or major morbidity related to the procedure. Three patients died of existing disease within 30 days; one had peritoneal irritation following dislodgement of the catheter two days after the procedure but responded to conservative treatment with antibiotics alone. The authors conclude that this procedure is simple and safe and represents the preferred method of gastrostomy for enteral feeding.     

Percutaneous gastrostomy in a child

A 2-year-old girl with cyanotic congenital heart disease needed to undergo gastrostomy. To avoid the use of general anesthesia, a percutaneous gastrostomy was performed as an interventional radiologic procedure with the patient under sedation and with the use of local anesthesia. The placement of a nasogastrocutaneous guide wire under fluoroscopic guidance provided a stable tract for placement of the gastrostomy tube.     

Percutaneous nonendoscopic gastrostomy in children

Surgical gastrostomy has long been a standard method of providing nutrition to infants and children. Recently, percutaneous endoscopic gastrostomy has been advocated as a safer, quicker, less expensive method in children. We report our experience with 16 percutaneous gastrostomies in 14 infants and children; in all cases, both sonographic and fluoroscopic guidance were used. Four patients had had previous surgical gastrostomy in which the tubes could not be replaced once they were removed. The remaining patients were referred for percutaneous placement of gastrostomy tubes as the first procedure. In 13 procedures, parenteral sedation and local anesthesia were used; the remaining three procedures were done with the patient under general anesthesia. Tubes were successfully placed in all procedures. In two patients, tubes became dislodged, necessitating a second procedure. There were no instances of local infections, hemorrhage, or peritonitis, and none of the patients died. Two patients had postprocedure septicemia, which responded to antibiotics. Percutaneous nonendoscopic gastrostomy can be safely and effectively performed in infants and children.     

Percutaneous gastrostomy and transgastric jejunostomy.

Gastrostomy for feeding or decompression of the stomach or small intestine can be performed by using surgical or percutaneous, nonsurgical techniques. Although use of the surgical technique is well established, recent interest has focused on the nonsurgical methods because of their lower rates of morbidity. Percutaneous gastrostomy by either the endoscopic or the fluoroscopically guided Seldinger technique was introduced in the early 1980s. A number of technical modifications have been described, and sufficient clinical data have been accumulated and published to validate the safety of the percutaneous approach. Several published studies compare surgical with nonsurgical gastrostomy, but none compare the two percutaneous techniques. The purpose of this article is to review the current status of the fluoroscopically guided technique, its indications, and its results and to examine the relative merits of the surgical and nonsurgical techniques.     

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 gastrostomy and gastroenterostomy: 2. Clinical experience

This report describes the authors' initial experience with percutaneous gastrostomy (PG) and gastroenterostomy (PGE) in 40 patients. Indications for PG and PGE included alimentation (35 patients) and small bowel decompression (five). Seldinger technique with air distension of the stomach via a nasogastric tube (20 patients) is a simple method to insert small (7-9 French) and firm catheters; tube exchanges for larger and softer catheters often are necessary by this method (23 procedures in 17 patients). Coaxial trocar technique (19 patients) permits initial insertion of softer and often larger catheters (9-14 French feeding tubes), which are less likely to clog or require exchange; the intragastric balloon support method facilitates trocar insertion. Now preferred is a system that uses 18-gauge needle puncture and allows coaxial insertion of a final soft feeding tube at the initial procedure. Small bowel catheter positioning (PGE) (31 patients) was more common than gastrostomy alone (8 patients); "downhill puncture" toward the gastric antrum assists direct guide-wire cannulation of the duodenum via the gastric puncture (12 patients). Five complications occurred; two were major and included catheter dislodgement in one patient. Another patient, who had a pharyngeal tumor, suffered profound respiratory difficulty from premedication and nasogastric tube malposition; patients with head and neck tumors present particular problems with nasogastric tube passage and airway monitoring. Inability to pass a nasogastric tube does not preclude PG and PGE, as direct puncture of the stomach is feasible.