CT Fluoroscopy Guided Percutaneous Gastrostomy or Jejunostomy Without (CT-PG/PJ) or with Simultaneous Endoscopy (CT-PEG/PEJ) in Otherwise Untreatable Patients

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2012 Dec 13

PMID 23232989

Citations 9

Authors

Fritz W Spelsberg

Ralf-Thorsten Hoffmann

Reinhold A Lang

Hauke Winter

Rolf Weidenhagen

Maximilian Reiser

Karl-Walter Jauch

Christoph Trumm

Affiliations

Soon will be listed here.

Abstract

Purpose: Percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) are substantial for patients with swallowing disorders to maintain enteral nutrition or to decompress palliatively intractable small bowel obstruction. Endoscopic placement can be impossible due to previous (gastric) operation, obesity, hepato-splenomegaly, peritoneal carcinosis, inadequate transillumination, or obstructed passage. Computed tomography (CT)-fluoroscopic guidance with or without endoscopy can enable placement of CT-PG/CT-PJ or CT-PEG/CT-PEJ if endoscopically guided placement fails. In this retrospective study, we will evaluate the feasibility and safety of this method.

Methods: A total of 101 consecutive patients were referred to our department for feeding support (n = 87) or decompression (n = 14). Reasons were: ENT tumor (n = 51), esophageal cancer (n = 19), mediastinal mass (n = 2), neurological disorder (n = 15). Decompression tubes were placed because of cancer (n = 13) or Crohn's disease (n = 1). The following approaches were chosen: CT fluoroscopy and simultaneous gastroscopy (n = 61), inflation of the stomach via nasogastric tube (n = 29), and direct puncture under CT-fluoroscopic guidance (n = 11).

Results: CT fluoroscopy-guided gastrostomy was feasible in 89 of 101 patients. No procedure-related mortality was observed. One tube was misplaced into the colon in a patient with a history of gastrectomy. No complication was seen after removal. Minor complications: dislodgement (n = 17), peristomal leakage (n = 7), wound infection (n = 1), superficial skin infection (n = 6), tube obstruction (n = 2).

Conclusions: CT fluoroscopy-guided PG/PJ or PEG/PEJ is feasible and safe and provides adequate feeding support or decompression. It offers the benefits of minimally invasive therapy even in patients with contraindications to established endoscopic methods, combining the advantages of both techniques. Long-term complications-mainly tube-related problems-are easily treated.

Citing Articles

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CT Fluoroscopy-Guided Percutaneous Gastrostomy in the Palliative Management of Advanced and Relapsed Ovarian Cancer: The Charité Experiences and a Review of the Literature.

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Safety and Efficacy of CT-Guided Central Venous Catheter Gastric Insufflation in Percutaneous Gastrostomy.

Zhang W, Deng R, Chen B, Lv J, Zhu T, Huang M Biomed Res Int. 2022; 2022:9421738.

PMID: 36212722 PMC: 9537001. DOI: 10.1155/2022/9421738.

Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population.

Maasarani S, Khalid S, Creighton C, Manatis-Lornell A, Wiegmann A, Terranella S Surg Open Sci. 2021; 3:2-7.

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Endoscopy in the CT Scanner: a Multidisciplinary Approach to Difficult Cases.

DeLong C, Sarwani N, Mahraj R, Pauli E J Gastrointest Surg. 2020; 25(3):866-867.

PMID: 33169318 DOI: 10.1007/s11605-020-04840-y.

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