Percutaneous Radiologic Gastrostomy With and Without T-Fastener Gastropexy: A Randomized Comparison Study

Thornton, Frank J.; Fotheringham, Tim; Haslam, Philip; McGrath, Frank P.; Keeling, F.; Lee, M. J.

doi:10.1007/s00270-001-0089-4

Cited by 93 publications

(52 citation statements)

References 8 publications

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“…8 We performed gastrostomy insertions with the use of T-fastener because of the absence of procedure related deaths, tube extrusion into the peritoneal space: gastropexy devices stabilize the stomach during PRG, provide added security against tract disruption in the first few days following catheter placement, reduce risk of site hemorrhage, help to prevent leakage of ascites around a gastrostomy catheter and is simple to use. 3,5,9 Such anchors have to be cut 5-10 days post-insertion in order to avoid a foreign body reaction, inflammation, or damage to the gastric mucosa. Peristomal leakages, skin infections, and persistent drainage after removal of the gastrostomy catheters have been attributed to retain T-fastener.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 Serial dilatation of percutaneous gastric tract is done with Seldinger technique using dilators up to 12-14 F: finally, gastrostomy polyurethane (Wills Oglesby; Wilson Cook Inc., Bloomington, IN, USA) tube 12 F is placed, and fixed by means of a loop. 3 The correct position is checked again by injecting contrast through the tube; the stomach is then decompressed for at least 12 hours following the procedure. T-fasteners will be removed within 5-10 days, under fluoroscopic control.…”

Section: Procedures For First Placementmentioning

confidence: 99%

“…2 Percutaneous gastrostomy represents a valid alternative, less invasive than surgical approach and more tolerated from patients: it is an artificial entero-cutaneous fistula between stomach and the skin surface, and it can be obtained with endoscopic or radiologic method. 3 In the last years, PEG has quickly replaced the surgical approach and it is the current standard procedure to obtain a feeding access in these kind of patients. 4 The reasons of failure of the endoscopic approach are well known and allow the research of possible alternatives as percutaneous placement of feeding tubes like a valid option to surgery and endoscopy: the interventional approach is easy and fast as well as less invasive as compared to surgery.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Radiologic Gastrostomy: A 12-Year Series

et al. 2010

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Background/Aims: Interventional radiologists have played a main role in the technical evolution of gastrostomy, from the first surgical/endoscopical approaches to percutaneous interventional procedures. This study evaluated the results obtained in a 12-year series. Methods: During the period December 1996 to December 2008, 254 new consecutive gastrostomies and 275 replacement procedures were performed in selected patients. All of the cases were treated by a T-fastener gastropexy and tube placement. The procedures were assessed by analyzing indications, patient selection, duration of the procedures, and mortality. Results: All 254 first gastrostomies were successful; replacement procedures were also successfully performed. One (0.2%) patient with severe neurologic disorders died after the procedure without signs of procedure-related complications, and seven (1.3%) major complications occurred (four duodenal lesions with peritoneal leakage, two gastric bleedings, and one gastric lesion). Minor complications were easily managed; three tube ruptures were resolved. Conclusions: This long-term series and follow-up showed that a group of interventional radiologist can effectively provide gastrostomy placement and long-term tube management. Percutaneous gastrostomy is less invasive than other approaches and it satisfies the needs even of high-risk patients. (Gut Liver 2010;4(Suppl. 1):S44-49)

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Section: Discussionmentioning

confidence: 99%

Section: Procedures For First Placementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous Radiologic Gastrostomy: A 12-Year Series

et al. 2010

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“…Mildenberger et al [12], in a mixed cohort of 90 percutaneous radiographic gastro-and enterostomies, indicate a mean fluoroscopy time of 12.6 minutes; however, almost 1/3 of these were distinctly complex duodenal or jejunostomies. In a comparison between PRG with and without gastropexy, Thornton et al [11] reported a fluoroscopy time of 4.73 minutes with gastropexy and 4.59 minutes without the procedure. However, there was no indication of whether these were median or mean values.…”

Section: Discussionmentioning

confidence: 99%

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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“…Although the performance of gas- tropexy has remained somewhat controversial, one prospective randomized study has shown that it reduces the risk of initial intraperitoneal tube placement and obviates subsequent tube migration through the formation of adhesions. 6 For PRGJ or PRJ tube placement, gastropexy is standard. If gastropexy is not used, continuous air insufflations may be necessary during the procedure to keep the stomach distended.…”

Section: Techniquementioning

confidence: 99%