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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 7/2016

01-07-2016 | CIRSE Standards of Practice Guidelines

CIRSE Standards of Practice Guidelines on Gastrostomy

Authors: James Sutcliffe, Andrew Wigham, Niall Mceniff, Petr Dvorak, Laura Crocetti, Raman Uberoi

Published in: CardioVascular and Interventional Radiology | Issue 7/2016

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Abstract

Purpose

Surgical Gastrostomy has been around since the 19th century but in 1980 the first successful percutaneous endoscopic gastrostomy was reported. A year later the first successful percutaneous gastrostomy was performed using fluoroscopic guidance. The technique for percutaneous insertion and the equipment used has been refined since then and it is now considered the gold standard for gastrostomy insertion. Here we present guidelines for image-guided enteral feeding tubes in adults.

Material and Method

We performed a review and analysis of the scientific literature, other national and international guidelines and expert opinion.

Results

Studies have shown fluoroscopic techniques have consistently higher success rates with lower rates of major complications than endoscopic techniques. However, the Achilles' heel of many fluoroscopic techniques is the requirement for smaller gastrostomy tube sizes resulting in them being more prone to blockages and thus requiring further intervention.

Conclusion

Radiological feeding tube insertion is a safe and effective procedure. Success rates are higher, and complication rates lower than PEG or surgical gastrostomy tube placement and innovative techniques for gastric and jejunal access mean that there are very few cases in which RIG is not possible. The principal weakness of radiologically inserted gastrostomies is the limitiation on tube size which leads to a higher rate of tube blockage. Per-oral image-guided gastrostomies have to an extent addressed this but have not been popularised. Currently many centres still consider endoscopic gastrostomies as the first line unless patients are too unwell to undergo this procedure or previous attempts have failed, in which case radioloically inserted gastrostomies are the technique of choice.
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Metadata
Title
CIRSE Standards of Practice Guidelines on Gastrostomy
Authors
James Sutcliffe
Andrew Wigham
Niall Mceniff
Petr Dvorak
Laura Crocetti
Raman Uberoi
Publication date
01-07-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 7/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1344-z

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