Abstract
Introduction
Gastrostomy tube placement for patients requiring long-term nutritional support may be performed using different techniques including endoscopic, surgical, and percutaneous radiologically guided methods. Radiologically inserted gastrostomy (RIG), typically performed when percutaneous endoscopic gastrostomy is not possible, requires proper gastric distension that is achieved by insufflating air through a nasogastric tube. We describe a simple technique to prevent air escape from the stomach during gastrostomy tube placement. To the best of our knowledge, this technique has not yet been described in the literature.
Materials and Methods
Four patients with unsuccessful percutaneous endoscopic gastrostomy were referred for fluoroscopic-guided gastrostomy. One patient had a pyriform sinus tumor and three had an ischemic stroke causing dysphagia. Gastric distention was not achieved in the patients due to air escaping into the bowel during the standard RIG procedure. A modified approach using a balloon catheter inflated in the pylorus to avoid air passing into the duodenum permitted successful RIG.
Results
The modified RIG procedure was successfully carried out in all cases without complications.
Discussion
Inadequate air distension of the stomach is an unusual event that causes a failure of gastrostomy tube placement and an increased risk of both major and minor complications. The use of a balloon catheter inflated in the first part of the duodenum prevents the air passage into the bowel allowing the correct positioning of the gastrostomy.
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All authors have read and approved the manuscript, and, subject acceptance, authors will transfer copyright to the Publisher; there is no ethical problem or conflict of interest, and there has been no duplicate publication or submission elsewhere.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in this study.
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Petrocelli, F., Salsano, G., Bovio, G. et al. Radiologic Percutaneous Gastrostomy in Nondistended Stomach: A Modified Approach. Cardiovasc Intervent Radiol 39, 1045–1049 (2016). https://doi.org/10.1007/s00270-016-1304-7
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DOI: https://doi.org/10.1007/s00270-016-1304-7