Percutaneous Gastrostomy with Fluoroscopic Guidance: Single-Center Experience in 500 Consecutive Cancer Patients

Baère, Thierry De; Chapot, René; Kuoch, Viseth; Chevallier, Philippe; Delille, J P; Domenge, C.; Schwaab, G; Roche, Alain

doi:10.1148/radiology.210.3.r99mr40651

Cited by 147 publications

(93 citation statements)

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“…However, this fact does not appear to affect the very high 99 % success rate of the procedure [2]. Due to the high proportion of tumor-or therapy-associated obstacles to passage, in our patient cohort placement of a nasogastric tube represented a particular challenge which could generally only be overcome using X-ray guidance.…”

Section: Discussionmentioning

confidence: 90%

“…In the case of 7 procedures an additional CBCT was necessary for the following reasons: to avoid puncturing structures in the access path (2), to rule out penetration of adjoining structures after puncturing the stomach (3), and after placing the PRG (3) to check the proper position of the feeding tube. In 5 of the 7 procedures a Billroth II procedure was an issue.…”

Section: Resultsmentioning

confidence: 99%

“…First, upper abdominal sonography was performed to mark the hepatic border. After placement of a nasogastric tube, the stomach was distended with ambient air [2,3,16], and extensive local anesthesia was performed from the cutis to the frontal wall of the stomach. Two gastropexies applied diametrically around the gastrostomy itself prevent diversion of the stomach during dilatation of the pathway.…”

Section: Methodsmentioning

confidence: 99%

“…Unlike PEG, PRG has to be performed using image guidance and a nasogastric tube by means of gastric insufflation. Since its initial description in 1981 [1] PRG is generally performed using X-ray fluoroscopy [2]. Alternate or complementary imaging procedures for guiding the intervention are sonography, cone beam computed tomography (CBCT), or computed tomography (CT).…”

Section: Introductionmentioning

confidence: 99%

“…Ergebnisse Das mediane DFP von PRG-Anlagen unter DL lag bei 163 cGy*cm 2 (FD: 155 cGy*cm 2 ; BV: 175 cGy*cm 2 ). Die mediane DLZ betrug 2,2 min.…”

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Analysis of Patients’ X-ray Exposure in 146 Percutaneous Radiologic Gastrostomies

Petersen¹,

Reinhardt²,

Fuchs³

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TPurpose Analysis of patient´s X-ray exposure during percutaneous radiologic gastrostomies (PRG) in a larger population. Materials and MethodsData of primary successful PRGprocedures, performed between 2004 and 2015 in 146 patients, were analyzed regarding the exposition to X-ray. Dose-area-product (DAP), dose-length-product (DLP) respectively, and fluoroscopy time (FT) were correlated with the used x-ray systems (Flatpanel Detector (FD) vs. Image Itensifier (BV)) and the necessity for periprocedural placement of a nasogastric tube. Additionally, the effective X-ray dose for PRG placement using fluoroscopy (DL), computed tomography (CT), and cone beam CT (CBCT) was estimated using a conversion factor. ResultsThe median DFP of PRG-placements under fluoroscopy was 163 cGy*cm 2 (flat panel detector systems: 155 cGy*cm 2 ; X-ray image intensifier: 175 cGy*cm 2 ). The median DLZ was 2.2 min. Intraprocedural placement of a naso-or orogastric probe (n = 68) resulted in a significant prolongation of the median DLZ to 2.5 min versus 2 min in patients with an already existing probe. In addition, dose values were analyzed in smaller samples of patients in which the PRG was placed under CBCT (n = 7, median DFP = 2635 cGy*cm 2 ), or using CT (n = 4, median DLP = 657 mGy*cm). Estimates of the median DFP and DLP showed effective doses of 0.3 mSv for DL-assisted placements (flat panel detector 0.3 mSv, X-ray image converter 0.4 mSv), 7.9 mSv using a CBCT -flat detector, and 9.9 mSv using CT. This corresponds to a factor 26 of DL versus CBCT, or a factor 33 of DL versus CT.Conclusion In order to minimize X-ray exposure during PRGprocedures for patients and staff, fluoroscopically-guided interventions should employ flat detector systems with short transmittance sequences in low dose mode and with slow image frequency. Series recordings can be dispensed with. The intraprocedural placement of a naso-or orogastric probe significantly extends FT, but has little effect on the overall dose of the intervention. Due to the significantly higher X-ray exposure, the use of a CBCT as well as PRG-placements using CT should be limited to clinically absolutely necessary exceptions with strict indication. Ergebnisse Das mediane DFP von PRG-Anlagen unter DL lag bei 163 cGy*cm 2 (FD: 155 cGy*cm 2 ; BV: 175 cGy*cm 2 ). Die mediane DLZ betrug 2,2 min. Dabei führte eine intraprozedurale Anlage einer naso-oder orogastralen Sonde (n = 68) zu einer signifikanten Verlängerung der medianen DLZ auf 2,5 min gegenüber 2 min bei Patienten mit bereits liegender Sonde. Zusätzlich wurden Dosiswerte von kleineren Patientengruppen analysiert, bei denen die PRG CBCT-gestützt (n = 7; medianes DFP = 2635 cGy*cm 2 ), oder CT-gestützt (n = 4, medianes DLP = 657 mGy*cm) angelegt wurde. Durch Abschätzungen aus den medianen DFP bzw. DLP ergaben sich effektive Dosen von 0,3 mSv für DL-gestützte Anlagen (FD 0,3 mSv; BV 0,4 mSv), mittels FD mit CBCT 7,9 mSv, und bei PRG-Anlagen im CT eine effektive Dosis von 9,9 mSv. Das entspricht einem Faktor 26 von DL gegenüber ...

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Section: Discussionmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%