Updates on Percutaneous Radiologic Gastrostomy/Gastrojejunostomy and Jejunostomy

Shin, Ji Hoon; Park, Auh-Whan

doi:10.5009/gnl.2010.4.s1.s25

Cited by 61 publications

(44 citation statements)

References 19 publications

(25 reference statements)

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“…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%

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: Methodsmentioning

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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“…Complications associated with both procedures include: catheter dysfunction, aspiration, pericatheter leakage, peritonitis, sepsis, and cecal/gastric trauma. However, if done with proper technique and appropriate catheter care these complications can be avoided and are rare [67,68].…”

Section: Decompressive Gastrostomies or Cecostomies For Gastric And Bmentioning

confidence: 99%

The role of interventional oncology in the palliative care of cancer patients

Hussaini

Kang

et al. 2016

Expert Review of Quality of Life in Cancer Care

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Interventional oncologists have expertise in delivery of state of the art, minimally invasive, imageguided procedures. As such, interventional oncologists are well-suited to provide palliative options for cancer patients, who often have complex comorbidities precluding them from more invasive options. The broad spectrum of procedures developed into clinical practice highlight the integral role of interventional oncology in the palliation of cancer patients. This review will focus on several of the more common procedures performed by interventional oncologists to provide symptomatic relief: 1. Tunneled peritoneal or pleural catheter placement for fluid drainage; Peritoneovenous shunt placement for fluid drainage; 2. Ablation with focus on metastatic bone ablation for pain control; 3. Neurolysis with focus on celiac neurolysis for pain control; 4. Decompressive gastrostomies or cecostomies for gastric and bowel obstruction; 5. Transarterial embolization for uncontrolled hemorrhage. A description of each procedure and its relative efficacy in providing palliation will be summarized. ARTICLE HISTORY

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“…As an alternative to endoscopically-placed jejunostomy tubes, fluoroscopicallyguided catheters can be placed. Percutaneous radiologic gastrojejunostomy (PRGJ) involves a longer and narrower tube than that placed in the stomach, and is thought to carry the potential for more frequent complications, such as tube blockage; PRGJ can be considered as a conversion from gastrostomy or placed as a primary option (Given et al, 2005;Shin & Park, 2010;Hoffer et al, 1999). Percutaneous radiologic jejunostomy (PRJ) is indicated in patients whose stomach is inaccessible for gastrostomy placement, or in those who have had a previous gastrectomy (Given et al, 2005;Shin & Park, 2010).…”

Section: Post-pyloric Accessmentioning

confidence: 99%