CardioVascular and Interventional Radiology

, Volume 39, Issue 7, pp 973–987 | Cite as

CIRSE Standards of Practice Guidelines on Gastrostomy

  • James Sutcliffe
  • Andrew Wigham
  • Niall Mceniff
  • Petr Dvorak
  • Laura Crocetti
  • Raman Uberoi
CIRSE Standards of Practice Guidelines



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.


Gastrojejunostomy/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 


Compliance with Ethical Standards

Conflict of interest



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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  • James Sutcliffe
    • 1
  • Andrew Wigham
    • 1
  • Niall Mceniff
    • 2
  • Petr Dvorak
    • 3
  • Laura Crocetti
    • 4
  • Raman Uberoi
    • 1
  1. 1.Radiology DepartmentOxford University Hospitals NHS TrustOxfordUK
  2. 2.Radiology (DiagIm)St. James’s HospitalDublinIreland
  3. 3.Radiology DepartmentFaculty Hospital Charles UniversityPragueCzech Republic
  4. 4.Diagnostic Imaging and Intervention, Department of Hepatology and Liver TransplantsUniversity of PisaPisaItaly

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