Patients with a history of RYGB present a technical challenge for excluded gastric remnant gastrostomy placement. As the RYGB population increases and ages, obtaining and maintaining access to the gastric remnant is likely to become an important part of interventional radiology's role in the management of the bariatric patient.

No abstract

A retrospective review of technique and peri-procedural complications was performed for each patient. Major and minor complications were stratified based on the SIR reporting standards (2). Insufflation of the stomach was achieved under fluoroscopic guidance using one of three methods: nasogastric tube; direct stick with a 21G Chiba needle; or Effervescent Granules with subsequent direct stick. Results: PRG was successful in 88% of patients. PRG was not attempted in 3 patients due to an elevated left hemidiaphragm or prior surgery. Minor complications were seen in 27.2% (leakage (4.5%), granulation tissue (9.1%), and local infection (13.6%)), lower than reported PRG rates of 32% (3). One major complication occurred (4.5%), which is lower than reported rates (14.3%) in endoscopic gastrostomy placement (3). This patient developed aspiration pneumonia and respiratory distress 5 days post-operatively and required ICU admission. Direct stick (33.3%) and effervescent (25%) techniques had lower minor complication rates than NGT insufflation (33.3%). Conclusions: The presented techniques for PRG placement are safe and effective for enteral nutrition in ALS patients with the added benefit of not requiring intubation or ventilatory support.