CIRSE Standards of Practice Guidelines on Gastrostomy
Surgical Gastrostomy has been around since the 19th century but in 1980 the first successful percutaneous endoscopic gastrostomy was reported. A year later the first successful percutaneous gastrostomy was performed using fluoroscopic guidance. The technique for percutaneous insertion and the equipment used has been refined since then and it is now considered the gold standard for gastrostomy insertion. Here we present guidelines for image-guided enteral feeding tubes in adults.
Material and Method
We performed a review and analysis of the scientific literature, other national and international guidelines and expert opinion.
Studies have shown fluoroscopic techniques have consistently higher success rates with lower rates of major complications than endoscopic techniques. However, the Achilles' heel of many fluoroscopic techniques is the requirement for smaller gastrostomy tube sizes resulting in them being more prone to blockages and thus requiring further intervention.
Radiological feeding tube insertion is a safe and effective procedure. Success rates are higher, and complication rates lower than PEG or surgical gastrostomy tube placement and innovative techniques for gastric and jejunal access mean that there are very few cases in which RIG is not possible. The principal weakness of radiologically inserted gastrostomies is the limitiation on tube size which leads to a higher rate of tube blockage. Per-oral image-guided gastrostomies have to an extent addressed this but have not been popularised. Currently many centres still consider endoscopic gastrostomies as the first line unless patients are too unwell to undergo this procedure or previous attempts have failed, in which case radioloically inserted gastrostomies are the technique of choice.
KeywordsGastrojejunostomy/percutaneous endoscopic gastrostomy (PEG) Radiologically inserted gastrostomy (RIG) Per-oral image-guided gastrostomy (PIG) Subspecialty/technique Enteral feeding Sub-specialty/technique Non-vascular interventions Specialty Gastrointestinal Organ Stroke Disease
- 3.McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enter Nutr. 2009;33(3):277–316.CrossRefGoogle Scholar
- 12.Itkin M, Delegge MH, Fang JC, McClave SA, Kundu S, Janne B, et al. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Intervention. J Vasc Interv Radiol. 2011;22(8):1089–106.CrossRefPubMedGoogle Scholar
- 21.Stroud M. Guidelines for enteral feeding in adult hospital patients. Gut. 2003;52(Suppl 7):vii1–12.Google Scholar
- 48.Agency National Patient Safety. Patient safety update. London: WHO Surgical Safety Checklist; 2010.Google Scholar
- 49.Lee MJ. Strategies to minimise complications: safety check list. Cardiovasc Intervent Radiol. 2012;35(1):S9.Google Scholar
- 52.International Commission on Radiological Protection. Radiological Protection and Safety In Medicine. ICRP Publication 73, Ann. 1996;26(2).Google Scholar
- 53.European Commission. Council Directive 97/43/EURATOM of 30 June 1997 on Health Protection of Individuals Against the Dangers of Ionizing Radiation in Relation to Medical Exposure. Off J Eur Communities L. 1997;180:22–7.Google Scholar
- 55.Cardiovascular and Interventional Radiology Society of Europe. European Board of Interventional Radiology [Internet]. [cited 2015 Jan 1]. http://www.cirse.org/index.php?pid=473.
- 76.Bradnam V, White R. Handbook of drug administration via enteral feeding tubes. 2nd ed. London: Pharmaceutical Press; 2010.Google Scholar
- 89.Perona F, Castellazzi G, De Iuliis A, Rizzo L. Percutaneous radiologic gastrostomy: a 12-year series. Gut Liver. 2010;4(Suppl 1):S44–9.Google Scholar
- 94.Stiglick AJ, Baerlocher MO, Asch M, Myers A, Ho CS. Percutaneous feeding tubes. Can Fam Phys. 2008;54(9):1255–7.Google Scholar