Percutaneous radiological gastrostomy and gastrojejunostomy: An alternative method for long term enteric feeding

Year 2012, Volume: 39 Issue: 4, 518 - 523, 01.12.2012

Aslıhan Semiz Oysu Yaşar Bükte

https://doi.org/10.5798/diclemedj.0921.2012.04.0193

Abstract

Objectives: In this study it was aimed to investigate the safety and technical success of percutaneous radiological gastrostomy and gastrojejunostomy. Materials and Methods: Results of 35 patients with a percutaneous gastrostomy or gastrojejunostomy are retrospectively evaluated. The indications for the procedure were dysphagia due to central nervous system disorders in 22, feeding disturbance due to oropharyngeal problems in 8 and excessive weight loss secondary to gastrointestinal system dysfunction in 5. The indications for percutaneous gastrojejunostomy were a history of aspiration, gastroesophageal reflux and diaphragmatic hernia. Results: Percutaneous radiological gastrostomy was performed in 22 and percutaneous gastrojejunostomy in 11 patients. In one patient, the procedure was not performed because of colonic superposition on the entire stomach, which precluded a safe access route. In another patient intervention was not successful. Minor complications, consisting of tube dislocation (n=2) and access site drainage (n=1) were seen in 3 (9%) patients. Major complications and 30 day mortality occurred in one (3%) patient. Conclusions: Percutaneous radiological gastrostomy and gastrojejunostomy are safe and effective methods with high technical success and low complication rates. Percutaneous radiological gastrostomy may be the method of choice for long term enteric feeding in patients, in whom endoscopy cannot be performed.

Keywords

Gastrostomy, gastrojejunostomy, percutaneous intervention, interventional radiology, enteral feeding.

Perkütan radyolojik gastrostomi ve gastrojejunostomi: Uzun dönem enterik beslenmede alternatif bir yöntem

Abstract

Amaç: Bu çalışmada perkütan radyolojik gastrostomi ve gastrojejunostominin güvenlik ve teknik başarısının araştırılması amaçlanmıştır. Gereç ve Yöntem: Perkütan gastrostomi ya da gastrojejunostomi uygulanmış olan 35 hastanın sonuçları retrospektif olarak incelendi. İşlem için endikasyonlar, 22 olguda santral sinir sistemi patolojisine bağlı yutma bozukluğu, 8 olguda orofaringeal problemler nedeniyle beslenememe ve 5 olguda gastrointestinal sistem disfonksiyonu nedeniyle aşırı kilo kaybı idi. Aspirasyon, diyafragma hernisi ya da gastroözofagial reflü öyküsü olan olgulara perkütan gastrojejunostomi uygulandı. Bulgular: Perkütan radyolojik gastrostomi 22 olguda, gastrojenunostomi ise 11 olguda uygulandı. Bir olguda kolonun mide üzerine süperpoze olması nedeniyle emniyetli giriş penceresi bulunamadığından işlem gerçekleştirilmedi. Bir olguda ise girişim yapılmasına karşın işlem başarılı olmadı. İşlem sonrasında 2 olguda tüp dislokasyonu ve 1 olguda giriş yeri akıntısı olmak üzere toplam 3 olguda (% 9) minör komplikasyon görüldü. İşlem sonrasında majör komplikasyon ve 30 günlük mortalite bir olguda (% 3) görüldü. Sonuç: Perkütan radyolojik gastrostomi ve gastrojejunostomi, yüksek teknik başarı ve düşük komplikasyon oranları ile etkin ve güvenli yöntemlerdir. Özellikle çeşitli nedenlerle endoskopi yapılamayan olgularda uzun dönemli enterik beslenme için perkütan radyolojik gastrostomi yöntemi tercih edilebilir.

Keywords

Gastrostomi, gastrojejunostomi, perkütan girişim, girişimsel radyoloji, enterik beslenme.

References

• Dewald CL, Hiette PO, Sewall LE, Fredenberg PG, Pal- estrant AM. Percutaneous gastrostomy and gastrojejunos- tomy with gastropexy: experience in 701 procedures. Radi- ology 1999;211(3):651-6.
• De Baere T, Chapot R, Kuoch V, et al. Percutaneous gas- trostomy with fluoroscopic guidance: single-center ex- perience in 500 consecutive cancer patients. Radiology 1999;210(3):651-4.
• Cosentini EP, Sautner T, Gnant M, Winkelbauer F, Teleky B, Jakesz R. Outcomes of surgical, percutaneous endoscop- ic, and percutaneous radiologic gastrostomies. Arch Surg 1998;133(10):1076-83.
• Beaver ME, Myers JN, Griffenberg L, Waugh K. Percuta- neous fluoroscopic gastrostomy tube placement in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 1998;124(10):1141-4.
• Norton B, Homer-Ward M, Donnelly MT, Long RG, Holmes GK. A randomized prospective comparison of percutane- ous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ 1996(7022);312:13-6.
• Park RH, Allison MC, Lang J, et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dys- phagia. BMJ 1992;304(6839):1406-9.
• Magné N, Marcy PY, Foa C, et al. Comparison between na- sogastric tube feeding and percutaneous fluoroscopic gas- trostomy in advanced head and neck cancer patients. Eur Arch Otorhinolaryngol 2001;258(2):89-92.
• Pitman AG, Lau PH, Lau WF, Beaty C, McKenzie AF. Fluo- roscopically guided percutaneous radiological gastrosto- my: technique, methodology and pitfalls. Australas Radiol 2003;47(2):205-12.
• Lee MJ. GI tract intervention. In: Kaufman JA, Lee MJ. Vas- cular and Interventional Radiology: The Requisites, 1st ed. Philadelphia, PA, ABD. Mosby, Elsevier, 2004:521-557.
• Chiò A, Galletti R, Finocchiaro C, et al. Percutaneous ra- diological gastrostomy: a safe and effective method of nu- tritional tube placement in advanced ALS. J Neurol Neuro- surg Psychiatry 2004;75(4):645-7.
• Sy K, Dipchand A, Atenafu E, et al. Safety and effective- ness of radiologic percutaneous gastrostomy and gastro jejunostomy in children with cardiac disease. AJR Am J Roentgenol 2008;191(4):1169-74.
• Wollman B, D’Agostino HB, Walus-Wigle JR, Easter DW, Beale A. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the litera- ture. Radiology 1995;197(3):699-704.
• Tok D, Ok G, Erbüyün K, Ertan Y, Çetin İ. Yoğun bakım ünitesinde perkütan endoskopik gastrostomi uygulamaları. Dicle Tıp Dergisi 2006;33(2):81-84.
• Funaki B, Zaleski GX, Lorenz J, et al. Radiologic gastrosto- my placement: pigtail- versus mushroom retained catheters. AJR Am J Roentgenol 2000;175(2):375-9.
• Funaki B, Peirce R, Lorenz J, et al. Comparison of balloon- and mushroom-retained large-bore gastrostomy catheters. AJR Am J Roentgenol 2001;177(2):359-62.
• Galaski A, Peng WW, Ellis M, Darling P, Common A, Tuck- er E. Gastrostomy tube placement by radiological versus endoscopic methods in an acute care setting: a retrospec- tive review of frequency, indications, complications and outcomes. Can J Gastroenterol 2009;23(2):109-14.