Download PDF
Semin intervent Radiol 2004; 21(3): 181-189
DOI: 10.1055/s-2004-860876
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Gastrostomy and Gastrojejunostomy

Stuart M. Lyon1 , 2 , Diane M. Pascoe2
  • 1Interventional Radiologist, Alfred Hospital, Melbourne, Australia
  • 2Department of Radiology, Alfred Hospital, Melbourne, Australia
Further Information

Publication History

Publication Date:
16 December 2004 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Gastrostomy allows enteral nutrition to continue in patients who are unable to meet their caloric requirements orally. Though the indications for gastrostomy placement are varied, dysphagia secondary to a neurological condition is the most common. These catheters were initially placed surgically, but percutaneous endoscopic placement is now the routine in most centers. Interventional radiologists have been performing this procedure under fluoroscopic guidance for several years with encouraging results. Percutaneous radiological gastrostomy is reported to have a success rate comparable to that of the endoscopic method, with lower morbidity and mortality rates. A further benefit is that it may be performed in patients for whom the endoscopic method would be difficult or dangerous, such as those with head and neck malignancies. One of the main factors currently limiting the use of this procedure is the shortage of interventional radiology facilities and specialists.

This article describes a technique for routine percutaneous radiological gastrostomy catheter placement and procedural variations for difficult cases. Indications and contraindications will be discussed, as will complication rates and how these compare with the traditional methods of gastrostomy tube placement.

KEYWORDS

Gastrostomy - gastrojejunostomy - interventional radiology

REFERENCES

  • 1 Cunha F. Gastostomy: its inception and evolution.  Am J Surg. 1946;  72 610-634
    CrossrefPubMedGoogle Scholar
  • 2 Schwartz S I, Ellis H. Maingot's Abdominal Operations. 8th ed. Norwalk, CT; Appleton-Century-Crofts 1985: 973
    Google Scholar
  • 3 Gauderer M W, Ponsky J L, Izant Jr R J. Gastrostomy without laparoscopy: a percutaneous endoscopic technique.  J Pediatr Surg. 1980;  15 872-875
    CrossrefPubMedGoogle Scholar
  • 4 Preshaw R M. A percutaneous method for inserting a feeding gastrostomy tube.  Surg Gynecol Obstet. 1981;  152 658-660
    PubMedGoogle Scholar
  • 5 McLoughlin R F, So C B, Gray R R. Fluoroscopically guided percutaneous gastrostomy: current status.  Can Assoc Radiol J. 1996;  47 10-15
    PubMedGoogle Scholar
  • 6 Given M F, Lyon S M, Lee M J. The role of the interventional radiologist in enteral alimentation.  Eur Radiol [serial online]. May 8, 2003;  , Accessed
    PubMedGoogle Scholar
  • 7 De Baere T, Chapot R, Kuoch V et al.. Percutaneous gastrostomy with fluoroscopic guidance: single centre experience in 500 consecutive cancer patients.  Radiology. 1999;  210 651-654
    PubMedGoogle Scholar
  • 8 Dewald C L, Hiette P O, Sewall L E, Fredenberg P G, Palestrant A M. Percutaneous gastrostomy and gastrojejunostomy with gastropexy; experience in 701 procedures.  Radiology. 1999;  211 651-656
    CrossrefPubMedGoogle Scholar
  • 9 Thornton F J, Fotheringham T, Haslam P J et al.. Percutaneous radiological gastrostomy with and without T-fastener gastropexy: a randomised comparison study.  Cardiovasc Intervent Radiol. 2002;  25 467-471
    CrossrefPubMedGoogle Scholar
  • 10 McFarland E G, Lee M J, Boland G W, Mueller P R. Gastropexy breakdown and peritonitis after percutaneous gastrojejunostomy in a patient with ascites.  AJR Am J Roentgenol. 1995;  164 189-193
    PubMedGoogle Scholar
  • 11 Gauderer M W, Stellato T A, Wade D C. Complications related to gastrostomy button placement.  Gastrointest Endosc. 1993;  39 467
    PubMedGoogle Scholar
  • 12 Bell S D, Carmody E A, Yeung E Y, Thurston W A, Simmons M E, Ho C S. Percutaneous gastrostomy and gastrojejunostomy: additional experience in 519 patients.  Radiology. 1995;  194 817-820
    PubMedGoogle Scholar
  • 13 Van Sonnenberg E, Wittich G R, Cabrera O A et al.. Percutaneous gastrostomy and gastrojejunostomy: clinical experience.  AJR Am J Roentgenol. 1986;  146 581-586
    PubMedGoogle Scholar
  • 14 Gray R R, St Louis E L, Grosman H. Modified catheter for percutaneous gastrojejunostomy.  Radiology. 1989;  173 276-278
    PubMedGoogle Scholar
  • 15 Saini S, Mueller P R, Gaa J et al.. Percutaneous gastrostomy with gastropexy: experience in 125 patients.  AJR Am J Roentgenol. 1990;  154 1003-1006
    CrossrefPubMedGoogle Scholar
  • 16 McLoughlin R F, Gibney R G. Fluoroscopically guided percutaneous gastrostomy: tube function and malfunction.  Abdom Imaging. 1994;  19 195-200
    PubMedGoogle Scholar
  • 17 Ho C S, Yeung E. Percutaneous gastrostomy and transgastric jejunostomy.  AJR Am J Roentgenol. 1992;  158 251-257
    PubMedGoogle Scholar
  • 18 Munk P L, Lee M J, Poon P Y et al.. Percutaneous gastrostomy in radiologic practice.  Australas Radiol. 1997;  41 342-350
    PubMedGoogle Scholar
  • 19 O'Dwyer T, Gullane P, Ho C S. Percutaneous feeding gastrostomy in patients with head and neck tumours: a five year review.  Laryngoscope. 1990;  100 29-32
    PubMedGoogle Scholar
  • 20 Luetzow A M, Chafoo R A, Young H. Percutaneous gastrostomy: the Stanford experience.  Laryngoscope. 1988;  98 1035-1039
    PubMedGoogle Scholar
  • 21 Shike M, Berner Y N, Gerdes H et al.. Percutaneous endoscopic gastrostomy and jejunostomy for long term feeding in patients with cancer of the head and neck.  Otolaryngol Head Neck Surg. 1989;  101 549-554
    PubMedGoogle Scholar
  • 22 O'Keeffe F, Carrasco C H, Charnsangavej C, Richli W R, Wallace S, Freedman R S. Percutaneous drainage and feeding gastrostomies in 100 patients.  Radiology. 1989;  172 341-343
    PubMedGoogle Scholar
  • 23 Wills J S, Oglesby J T. Percutaneous gastrostomy.  Radiology. 1983;  149 449-453
    PubMedGoogle Scholar
  • 24 Halkier B K, Ho C S, Yee A C. Percutaneous feeding gastrostomy with the Seldinger technique, review of 252 patients.  Radiology. 1989;  171 359-362
    CrossrefPubMedGoogle Scholar
  • 25 Campos A CL, Butters M, Meguid M M. Home enteral nutrition via gastrostomy in advanced head and neck cancer patients.  Head Neck. 1990;  12 137-142
    PubMedGoogle Scholar
  • 26 Thorburn D, Karim S N, Soutar D S, Mills P R. Tumour seeding following percutaneous endoscopic gastrostomy placement in head and neck cancer.  Postgrad Med J. 1997;  73 430-432
    CrossrefPubMedGoogle Scholar
  • 27 Strodel W E, Kenady D E. Stomal seeding of head and neck cancer by percutaneous endoscopic gastrostomy (PEG) tube.  Ann Surg Oncol. 1995;  2 462-463
    CrossrefPubMedGoogle Scholar
  • 28 Lee D S, Mhit-Tabatabai M A, Rush B F, Levine C. Stomal seeding of head and neck cancer by percutaneous endoscopic gastrostomy tube placement.  Ann Surg Oncol. 1995;  2 170-173
    CrossrefPubMedGoogle Scholar
  • 29 Schiano T D, Pfister D, Harrison L, Shike M. Neoplastic seeding as a complication of percutaneous endoscopic gastrostomy.  Am J Gastroenterol. 1994;  89 131-133
    PubMedGoogle Scholar
  • 30 Huang D T, Thomas G, Wilson W R. Stomal seeding by percutaneous endoscopic gastrostomy in patients with head and neck cancer.  Arch Otolaryngol Head Neck Surg. 1994;  118 658-659
    PubMedGoogle Scholar
  • 31 Clark J A, Pugash R A, Pantalone R R. Radiologic peroral gastrostomy.  J Vasc Interv Radiol. 1999;  10 927-932
    PubMedGoogle Scholar
  • 32 Keller M S, Lai S, Wagner D K. Percutaneous gastrostomy in a child.  Radiology. 1986;  160 261-262
    PubMedGoogle Scholar
  • 33 Van Sonnenberg E, Wittich G R, Edwards D K et al.. Percutaneous diagnostic and therapeutic interventional radiologic procedures in children: experience in 100 patients.  Radiology. 1987;  162 601-605
    PubMedGoogle Scholar
  • 34 Towbin R B, Ball W S, Bissett III G S. Percutaneous gastrostomy and percutaneous gastrojejunostomy in children: antegrade approach.  Radiology. 1988;  168 473-476
    PubMedGoogle Scholar
  • 35 Kanazawa S, Naomoto Y, Hiraki Y, Yasui K, Matsuno T. Percutaneous feeding gastrostomy in patients with partial gastrectomy: transhepatic approach with CT guidance.  Abdom Imaging. 1995;  20 302-306
    PubMedGoogle Scholar
  • 36 Sanchez R B, Van Sonnenberg E, D'Agostino H B, Goodacre B W, Moyers P, Casola G. CT guidance for percutaneous gastrostomy and gastroenterostomy.  Radiology. 1992;  184 201-205
    PubMedGoogle Scholar
  • 37 Wollman B, D'Agostino H B. Percutaneous radiologic and endoscopic gastrostomy: a 3-year institutional analysis of procedure performance.  AJR Am J Roentgenol. 1997;  169 1551-1553
    PubMedGoogle Scholar
  • 38 Brown A S, Mueller P R, Ferrucci J T. Controlled percutaneous gastrostomy: nylon T-fastener for fixation of the anterior gastric wall.  Radiology. 1986;  158 543-545
    PubMedGoogle Scholar
  • 39 Gray R R, Rooney M, Grosman H. Use of T-fasteners for primary jejunostomy.  Cardiovasc Intervent Radiol. 1990;  13 93-94
    PubMedGoogle Scholar
  • 40 Lyon S M, Haslam P J, Duke D M, McGrath F P, Lee M J. De novo placement of button gastrostomies in an adult population: experience in 53 patients.  J Vasc Interv Radiol. 2003;  14 1283-1289
    PubMedGoogle Scholar
  • 41 Moote D J, Ho C S, Felice V. Fluoroscopically guided percutaneous gastrostomy: is gastric fixation necessary?.  Can Assoc Radiol J. 1991;  42 113-118
    PubMedGoogle Scholar
  • 42 Rose D B, Wolman S L, Ho C S. Gastric haemorrhage complicating percutaneous transgastric jejunostomy.  Radiology. 1986;  161 835-836
    PubMedGoogle Scholar
  • 43 Lee M J, Saini S, Brink J A et al.. Malignant small bowel obstruction and ascites: not a contraindication to percutaneous gastrostomy.  Clin Radiol. 1991;  44 332-334
    CrossrefPubMedGoogle Scholar
  • 44 Deutsch L S, Kannegieter L, Vanson D T, Miller D P, Brandon J C. Simplified percutaneous gastrostomy.  Radiology. 1992;  184 181-183
    PubMedGoogle Scholar
  • 45 Chung R, Schertzer M. Pathogenesis of complications of percutaneous endoscopic gastrostomy: a lesson in surgical principles.  Am Surg. 1990;  56 134-137
    Google Scholar
  • 46 Laasch H U, Wilbraham L, Bullen K et al.. Gastrostomy insertion: comparing the options-PEG, RIG or PIG?.  Clin Radiol. 2003;  58 398-405
    CrossrefPubMedGoogle Scholar
  • 47 Szymski G X, Albazzaz A N, Funaki B et al.. Radiologically guided placement of pull-type gastrostomy tubes.  Radiology. 1997;  205 669-673
    PubMedGoogle Scholar
  • 48 Lee M J, Kiely P. Percutaneous radiological gastrostomy and gastrojejunostomy.  J Ir Coll Physicians Surg. 1998;  27 13-16
    PubMedGoogle Scholar
  • 49 Hicks M E, Surratt R S, Picus D, Marx M V, Lang E V. Fluoroscopically guided percutaneous gastrostomy and gastrojejunostomy: analysis of 158 consecutive cases.  AJR Am J Roentgenol. 1990;  154 725-728
    PubMedGoogle Scholar
  • 50 Mirich D R, Gray R R. Infracolic percutaneous gastrojejunostomy: technical note.  Cardiovasc Intervent Radiol. 1989;  12 340-341
    PubMedGoogle Scholar
  • 51 Hennigan T W, Forbes A. Colonic obstruction caused by endoscopic percutaneous gastrostomy.  Eur J Surg. 1992;  158 435
    PubMedGoogle Scholar
  • 52 Thornton F J, Varghese J L, Haslam P J, McGrath F P, Keeling F, Lee M J. Percutaneous gastrostomy in patients who fail or are unsuitable for endoscopic gastrostomy.  Cardiovasc Intervent Radiol. 2000;  23 279-284
    CrossrefPubMedGoogle Scholar
  • 53 Varney R A, Van Sonnenberg E, Giovanna C, Sukthankar R. Balloon techniques for percutaneous gastrostomy in a patient with partial gastrectomy.  Radiology. 1988;  167 69-70
    PubMedGoogle Scholar
  • 54 Van Sonnenberg E, Cubberly D A, Brown L K et al.. Percutaneous gastrostomy: use of intragastric balloon support.  Radiology. 1984;  152 531-532
    PubMedGoogle Scholar
  • 55 Stevens S D, Picus D, Hicks M et al.. Percutaneous gastrostomy and gastrojejunostomy after gastric surgery.  J Vasc Interv Radiol. 1992;  3 679-683
    PubMedGoogle Scholar
  • 56 Lee M J. PEG-is the E necessary? A comparison of percutaneous and endoscopic gastrostomy.  Clin Radiol. 1997;  52 77
    PubMedGoogle Scholar
  • 57 Hoffer E K, Cosgrove J M, Levin D Q, Herskowitz M M, Sclafani S J. Radiologic gastrojejunostomy and percutaneous endoscopic gastrostomy: a prospective randomised comparison.  J Vasc Interv Radiol. 1999;  10 413-420
    PubMedGoogle Scholar
  • 58 Wollman B, D'Agostino H B, Walus-Wigle J R, Easter D W, Beale A. Radiologic, endoscopic and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature.  Radiology. 1995;  197 699-704
    CrossrefPubMedGoogle Scholar
  • 59 Funaki B, Zaleski G X, Lorenz J et al.. Radiologic gastrostomy placement: pigtail versus mushroom-retained catheters.  AJR Am J Roentgenol. 2000;  175 375-379
    PubMedGoogle Scholar
  • 60 Funaki B, Pierce R, Lorenz J et al.. Comparison of balloon and mushroom-retained large-bore gastrostomy catheters.  AJR Am J Roentgenol. 2001;  177 359-362
    PubMedGoogle Scholar

S. M Lyon

Department of Radiology

Alfred Hospital, Commercial Rd, Prahran

VIC, 3004, Australia

Email: s.lyon@alfred.org.au

      >