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Cone-beam computed tomography–assisted percutaneous gastrostomy tube insertion in children with challenging anatomy

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Abstract

Background

Percutaneous radiological gastrostomy tube insertion is a common procedure in children. An approach using ultrasound and fluoroscopy may not be feasible in patients with challenging anatomy; therefore, advanced techniques or other imaging modalities may be required.

Objective

To describe our experience using cone-beam computed tomography (CT)–assisted percutaneous gastrostomy insertion in pediatric patients with challenging anatomy.

Materials and methods

A retrospective review was performed in children who underwent cone-beam CT–assisted percutaneous radiologic gastrostomy between January 2015 and July 2019. Indications, technique, outcomes, complications, and radiation dose (reference-point air kerma, air kerma area product) were assessed through chart and imaging review. Descriptive statistics only were used.

Results

Twenty-seven procedures were attempted in 26 patients. Reasons for utilizing cone-beam CT guidance were high-positioned stomach (n = 10), interposing bowel loops and liver (n = 19), omphalocele (n = 1), severe scoliosis (n = 1), and ventriculoperitoneal shunt (n = 1). Technical success was 85% (23/27). Mean procedure time was 96 min (range 50–131 min). No safe access route into the stomach was encountered in four patients; three were referred for surgical gastrostomy and one had a successful re-attempt. Radiation dose data was obtained from 19 procedures (17 successful) with a total dose in successful procedures ranging from 8.1 to 63.6 mGy (average 26.2 mGy, median 24.9 mGy). The number of cone-beam CT acquisitions per procedure ranged from 1 to 4. Major complication frequency was 11% (3/27) (bleeding, peritonitis, and aspiration pneumonia); minor complication frequency was 3.7% (1/27).

Conclusion

This study shows that cone-beam CT guidance can be useful for assisting percutaneous radiologic gastrostomy in children with challenging anatomy.

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Abbreviations

G-tube:

Gastrostomy tube

PEG:

Percutaneous endoscopic gastrostomy

US:

Ultrasound

VP:

Ventriculoperitoneal

CT:

Computed tomography

NPO:

Nil per os

Ka,r :

Reference-point air kerma

PKA :

Air kerma area product

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Author information

Authors and Affiliations

  1. Medical Imaging, University of Toronto, Toronto, ON, Canada

    Taryn J. Rohringer

  2. Diagnostic Radiology, McMaster University, Hamilton, ON, Canada

    Maria Gladkikh

  3. Division of Image Guided Therapy, Diagnostic Imaging Department, The Hospital for Sick Children, Room 2230A, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Maria Gladkikh, Nicholas A. Shkumat, Bairbre L. Connolly & Dimitri A. Parra

  4. Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Jirawadee Yodying

  5. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Nicholas A. Shkumat, Bairbre L. Connolly & Dimitri A. Parra

Authors
  1. Taryn J. Rohringer
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  2. Maria Gladkikh
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  3. Jirawadee Yodying
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  4. Nicholas A. Shkumat
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  5. Bairbre L. Connolly
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  6. Dimitri A. Parra
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Contributions

T. R. and M. G. collected and analyzed the data and wrote the first draft of the manuscript.

D. P. performed most of the procedures, was responsible for study design, participated in the data collection and in the drafting and review of the manuscript.

J. Y. participated in some procedures, collected, and analyzed data, and critically reviewed the manuscript.

N. S. performed the radiation data analyses and critically reviewed the manuscript.

B. C. performed data analysis and critically reviewed the manuscript.

All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Dimitri A. Parra.

Ethics declarations

Ethics approval

Approval was obtained from the Research Ethics Board of the Hospital for Sick Children (REB # 1000058981) and was performed in accordance with the principles of the Declaration of Helsinki. Due to the retrospective nature of the study, individual consent was waived, and all the procedures being performed were part of the routine care.

Conflicts of interests

The authors declare no competing interests.

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Rohringer, T.J., Gladkikh, M., Yodying, J. et al. Cone-beam computed tomography–assisted percutaneous gastrostomy tube insertion in children with challenging anatomy. Pediatr Radiol 53, 963–970 (2023). https://doi.org/10.1007/s00247-023-05593-x

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  • DOI: https://doi.org/10.1007/s00247-023-05593-x

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