Usefulness of computed tomography with air insufflation of the stomach prior to percutaneous endoscopic gastrostomy procedure

Safety and Efficacy of CT-Guided Central Venous Catheter Gastric Insufflation in Percutaneous Gastrostomy

Gastric insufflation for computed tomography (CT)-guided percutaneous gastrostomy is currently performed via a nasogastric tube or a Chiba needle. However, nasogastric tube placement requires patient pharynx and esophagus, and Chiba needle use is associated with an increased risk of organ damage and prolonged operation time. Herein, we introduce a new method of gastric insufflation via a central venous catheter and explore its safety and efficacy by retrospective analysis of the clinical data of patients who underwent percutaneous gastrostomy using this method in our hospital from April 2021 to March 2022. The extracted data included the following: success rate, operation time, gastric insufflation time, radiation dose, postoperative pain score, and complications. We also compared the preoperative levels of several nutritional indicators (body mass index, hemoglobin, albumin, creatinine, and blood urea nitrogen) with those obtained 1 month postoperatively. A total of 12 patients underwent percutaneous gastrostomy under CT guidance using central venous catheter gastric insufflation. The surgery and gastric insufflation success rates were 100% both. The average operation time, gastric insufflation time, and effective radiation dose were 24.08 ± 5.25 min, 5.08 ± 2.50 min, and 14.16 ± 3.63 mSv, respectively. Based on the World Health Organization scale for pain assessment, five patients reported no postoperative pain and seven patients had mild pain. There were no serious complications, such as stoma infection, peritonitis, gastrointestinal perforation and bleeding, or embedding syndrome. All evaluated nutritional indicators showed improvement at 1 month postoperatively, with statistically significant differences compared to the preoperative values (p < 0.05 for all). In conclusion, CT-guided percutaneous gastrostomy with central venous catheter gastric insufflation is a safe, effective, and feasible minimally invasive treatment.

Utility of pre-procedural CT and abdominal radiography before percutaneous radiologic gastrostomy placement

PURPOSE

To evaluate the utility of pre-procedural CT and abdominal radiography before percutaneous radiologic gastrostomy tube placement.

METHODS

A retrospective review of gastrostomy tube placements was conducted at a tertiary care radiology department. During the studied period, all percutaneous radiologic G-tube placements (PRG) at the institution required a pre-procedural abdominal CT. Whether the CT was interpreted to have an adequate window for PRG was recorded. The same patients with pre-procedural abdominal radiographs were also identified and retrospectively reviewed for the presence of satisfactory anatomy for PRG. Outcomes of tube placements were reviewed.

RESULTS

126 PRG requests were identified, all with abdominal CTs. 110 also had an abdominal radiograph. An adequate window for PRG was present in 83% of patients by CT and 73% by radiography. Of patients in whom it was attempted, 94% underwent successful PRG with a 7.4% minor complication rate. Of those refused for PRG based on CT, 9% had successful percutaneous endoscopic G-tube placement, resulting in a sensitivity of 98%. 97% of patients with satisfactory anatomy by radiograph underwent successful PRG. Of those with no window, 66% had a window by CT, and 94% in whom it was attempted had successful PRG placement. This resulted in a sensitivity of 77% for radiography. Concordance between CT and radiography was 73%.

CONCLUSIONS

Pre-procedural CT interpretation is highly predictive of successful and uncomplicated PRG. Abdominal radiography also predicts successful PRG, but with a lower accuracy, limiting its utility as a pre-procedural exam.