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Jung, Han, Jin, Choi, and Song: Comparison of Percutaneous Radiologic Gastrostomy by Using Cone Beam CT and Endoscopic Gastrostomy
Interventional Radiology

Journal of the Korean Society of Radiology 2014; 70(1): 17-23.

Published online: 14 January 2014

DOI: https://doi.org/10.3348/jksr.2014.70.1.17

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

Hyun Nyeong Jung, MD1, Young Min Han, MD1, 2, 3, Gong Yong Jin, MD1, 2, Eun Jeong Choi, MD1, Ji Soo Song, MD1

1Department of Radiology, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

2Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

3Institute of Cardiovascular Research, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

Corresponding author: Young Min Han, MD. Department of Diagnostic Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea. Tel. 82-63-250-1176, Fax. 82-63-272-0481, ymhan@jbnu.ac.kr

Received 28 February 2013       Accepted 18 November 2013

Copyright © 2014 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Gastrostomy, Fluoroscopy, Endoscopy

Figures and Tables

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.
jksr-70-17-g001
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
jksr-70-17-g002
Table 1
Patient Demographics
jksr-70-17-i001

Note.-Parentheses mean the percentage.

PEG = percutaneous endoscopic gastrostomy, PRG = percutaneous radiologic gastrostomy

Table 2
Comparison of Complication Rate and Tube Migration Rate between PRG and PEG Groups
jksr-70-17-i002

Note.-Parentheses mean the percentage.

PEG = percutaneous endoscopic gastrostomy, PRG = percutaneous radiologic gastrostomy

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