J Korean Soc Radiol.  2014 Jan;70(1):17-23. 10.3348/jksr.2014.70.1.17.

Comparison of Percutaneous Radiologic Gastrostomy by Using Cone Beam CT and Endoscopic Gastrostomy

• Jung HN
• Han YM
• Jin GY
• Choi EJ
• Song JS

• KMID: 1897255
• DOI: http://doi.org/10.3348/jksr.2014.70.1.17

Abstract

PURPOSE
To compare the effectiveness of percutaneous radiologic gastrostomy (PRG) by using cone beam CT and percutaneous endoscopic gastrostomy (PEG).
MATERIALS AND METHODS
This study retrospectively reviewed 129 patients who underwent PRG (n = 53) and PEG (n = 76) over a 2-years period. The C-arm cone beam CT images were obtained from all PRG patients before the procedure in order to decide the safest accessing routes. The parameters including technical success rates, complication rates and tube migration rates were all analyzed according to statistical methods.
RESULTS
The success rate of tube placement was higher in PRG than in PEG (100% to 93%, p = 0.08). Minor complications occurred in 5 patients of the PRG group (10%; 5/53, 3 wound infection, 2 blood oozing), and occurred in 6 patients of PEG group (7.9%; 6/76, 5 wound infection, 1 esophageal ulcer). Major complications occurred only in 5 patients of PEG group (6.6%; 5/76, 1 panperitonitis, 4 buried bumper syndrome). There were no statistical differences of minor and major complication rates in the two groups (respectively, p = 0.759, p = 0.078). Tube migration rate was lower in PRG than PEG group (7.5% vs. 38.2%, p < 0.005).
CONCLUSION
PRG using cone beam CT is the effective and safe method, the cone beam CT provides the safest accessing route during gastrostomy. Less tube migration occurs in the PRG than in PEG.

MeSH Terms

Cone-Beam Computed Tomography*
Endoscopy
Fluoroscopy
Gastrostomy*
Humans
Retrospective Studies
Wound Infection

Figure

• 

  Fig. 1 58-year-old man with dysphagia due to malignant neoplasm of hypopharynx. A. Axial image of cone beam CT was obtained. The metallic marker (arrow) shows appropriate site to puncture. Small bowel (asterisk) is laterally positioned to stomach. B. Sagittal image of cone beam CT shows small bowel loop (asterisk) positioned inferiorly and posteriorly to the stomach. C. Final tubogram shows the gastrostomy catheter is successfully inserted with good position. D. Four month later, gastrostomy tube was changed. The tubogram shows good position and function.

• 

  Fig. 2 74-year-old man with dysphagia due to esophageal cancer referred to PRG after failure of PEG procedure. A. PEG was failed due to circumferential luminal narrowing (arrows); pediatric endoscopy with the smallest diameter could not advance more. B. The stomach was distended with air insufflation through the Headhunter catheter (arrows) via nasogastric route. C. The appropriate site was punctured with the needle. The guide wire was inserted through the needle (arrowheads). D. The catheter was inserted through the guide wire. Injection of water-soluble contrast material through the catheter shows the confirmation of good position of catheter tip. Note.-PEG = percutaneous endoscopic gastrostomy, PRG = percutaneous radiologic gastrostomy

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