Korean J Radiol.  2011 Apr;12(2):216-219. 10.3348/kjr.2011.12.2.216.

Modified Radiology-Guided Percutaneous Gastrostomy (MRPG) for Patients with Complete Obstruction of the Upper Digestive Tract and Who are without Endoscopic or Nasogastric Access

• Chan SC
• Chu WC
• Liu KW
• Liao CT
• Lee TS
• Ng SH

• KMID: 1088567
• DOI: http://doi.org/10.3348/kjr.2011.12.2.216

Abstract

OBJECTIVE
We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract.
MATERIALS AND METHODS
Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fluoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fluoroscopic guidance) was performed in these patients.
RESULTS
We achieved successfully percutaneous gastrostomy using the modified technique in all patients without any major or minor complications after the procedure.
CONCLUSION
A modified radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract.

Keyword

Percutaneous gastrostomy; Complete obstruction; Upper digestive tract

MeSH Terms

Adult
Aged
Conscious Sedation
Contrast Media/diagnostic use
Esophageal Neoplasms/radiography/*surgery
Female
Gastrostomy/*methods
Humans
Intestinal Obstruction/radiography/*surgery
Iothalamate Meglumine/diagnostic use
Laryngeal Neoplasms/radiography/*surgery
Male
Middle Aged
Radiography, Interventional
Retrospective Studies
Upper Gastrointestinal Tract/radiography/*surgery

Figure

• 

  Fig. 1 Modified radiology-guided percutaneous gastrostomy technique. A. 21G fine needle punctured localized collection of air, which was visible in collapsed stomach under fluoroscopy-guided gastrostomy. Needle tip is then gradually withdrawn while injecting small amounts of water-soluble contrast medium. Location of stomach is confirmed by visualization of opacified gastric rugae. B. Stomach was inflated with approximately 600-800 mL of room air through 21G fine needle. C. 100-cm stainless steel guide wire is inserted through needle, and gastro-percutaneous tract is gradually dilated. D. Insertion of 14-Fr pigtail gastrostomy catheter and injection of small amount of water-soluble contrast medium via pigtail catheter confirmed that gastrostomy catheter is correctly placed within stomach.

Reference

1. Copeland EM 3rd, Daly JM, Dudrick SJ. Nutritional concepts in the treatment of head and neck malignancies. Head Neck Surg. 1979. 1:350–365.

2. Pezner RD, Archambeau JO, Lipsett JA, Kokal WA, Thayer W, Hill LR. Tube feeding enteral nutritional support in patients receiving radiation therapy for advanced head and neck cancer. Int J Radiat Oncol Biol Phys. 1987. 13:935–939.

3. Lee JH, Machtay M, Unger LD, Weinstein GS, Weber RS, Chalian AA, et al. Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch Otolaryngol Head Neck Surg. 1998. 124:871–875.

4. Wollman B, D'Agostino HB. Percutaneous radiologic and endoscopic gastrostomy: a 3-year institutional analysis of procedure performance. AJR Am J Roentgenol. 1997. 169:1551–1553.

5. Laasch HU, Wilbraham L, Bullen K, Marriott A, Lawrance JA, Johnson RJ, et al. Gastrostomy insertion: comparing the options--PEG, RIG or PIG? Clin Radiol. 2003. 58:398–405.

6. Chan SC, Ko SF, Ng SH, Cheung YC, Chang JT, Liao CT, et al. Fluoroscopically guided percutaneous gastrostomy with modified gastropexy and a large-bore balloon-retained catheter in patients with head and neck tumors. Acta Radiol. 2004. 45:130–135.

7. Seo TS, Song HY, Lee JH, Ko GY, Sung KB, Lim JO, et al. Newly designed sheaths for gastroduodenal intervention: an experimental study in a phantom and dogs. Korean J Radiol. 2004. 5:114–120.

8. Given MF, Hanson JJ, Lee MJ. Interventional radiology techniques for provision of enteral feeding. Cardiovasc Intervent Radiol. 2005. 28:692–703.

9. Laasch HU, Martin DF. Radiologic gastrostomy. Endoscopy. 2007. 39:247–255.

10. Wills JS, Oglesby JT. Percutaneous gastrostomy. Radiology. 1983. 149:449–453.

11. Ho CS. Percutaneous gastrostomy for jejunal feeding. Radiology. 1983. 149:595–596.

12. Tao HH, Gillies RR. Percutaneous feeding gastrostomy. AJR Am J Roentgenol. 1983. 141:793–794.

13. Barkmeier JM, Trerotola SO, Wiebke EA, Sherman S, Harris VJ, Snidow JJ, et al. Percutaneous radiologic, surgical endoscopic, and percutaneous endoscopic gastrostomy/gastrojejunostomy: comparative study and cost analysis. Cardiovasc Intervent Radiol. 1998. 21:324–328.

14. Rosenzweig TB, Palestrant AM, Esplin CA, Gilsdorf RB. A method for radiologic-assisted gastrostomy when percutaneous endoscopic gastrostomy is contraindicated. Am J Surg. 1994. 168:587–590.