Imaging of percutaneous tube gastrostomies: spectrum of normal and abnormal findings.

Abstract

Enteral alimentation is a crucial component of care for the malnourished patient who cannot eat. Until recently, long-term alimentation was delivered through nasogastric tubes or gastrostomy tubes placed at surgery. In the past few years, percutaneous endoscopic gastrostomy (PEG) has almost completely supplanted these traditional methods. PEG is a safer and better-tolerated procedure. The advantages of PEG over nasogastric tubes include greater social acceptance and improved cosmetic appearance, increased ease of feedings, and decreased nasal alar deformities and gastroesophageal reflux. Complications are less common with PEG than with open gastrostomy but still occur in as many as 15% of cases [1-3]. Percutaneous gastrostomies performed using fluoroscopic guidance have complications in approximately 10% of cases [4]. Despite a rapid increase in the use of percutaneous gastrostomies and their placement by radiologists [4], few published reports have described imaging findings after the placement of such tubes. This pictorial essay illustrates a spectrum of normal and abnormal imaging findings observed with the use of PEG tubes, including tube migration and misplacement, infection, tumor seeding along the PEG tube track, and a variety of gastric wall defects and pseudomasses.

Positioning a safe gastric puncture point before percutaneous endoscopic gastrostomy

“…Choice of this latter site for gastrostomy tube placement is based on several lines of reasoning. First, the area of greatest interface between the stomach and the anterior abdominal wall occurs in the lower body and antrum, not the fundus, and provides the shortest, most direct passage into the stomach (19). Even more important, this lower position within the stomach places the PEG tube in the antrum which facilitates conversion of the PEG to a percutaneous endoscopic gastrojejunostomy should the patient subsequently develop intolerance to PEG tube feeding (20).…”

Risk Factors and Risk Reduction of Malignant Seeding of the Percutaneous Endoscopic Gastrostomy Track from Pharyngoesophageal Malignancy: A Review of all 44 Known Reported Cases

“…Although the proposed mechanism in this case was hematogenous spread to a susceptible site (44), iatrogenic surgical implantation from contaminated surgical instruments was possible (13). § References include: (3,12,16,21,26,28,29,33,35,37,41). pharyngoesophageal cancer in general (50)).…”

“…The mean interval between PEG placement and stomal metastases was 7.8 ± 5.2 months (N = 41, range 3-30 months, excludes (29)). This confirms and extends the largest prior report of a mean interval of about 7 months (N = 30 (4)).…”

Safety of percutaneous endoscopic gastrostomy in high‐risk patients

“…It is now routine to place feeding tubes through a PEG in the anterior abdominal wall. The area of lower body of stomach provides the greatest interface between the stomach and the anterior abdominal wall . It provides the shortest, most direct passage into the stomach.…”