Interventional Radiology Techniques for Provision of Enteral Feeding

Abstract

Gastrostomy placement in patients who are unable to maintain their nutrition orally has been attempted using a variety of techniques over the past century. This includes surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy placement was the method of choice for almost a century, but has since been superseded by both endoscopic and radiological placement. There are a number of indications for gastrostomy placement in clinical practice today, with fewer contraindications due to the recent innovations in technique placement and gastrostomy catheter type. We describe the technique of gastrostomy placement, which we use in our institution, along with appropriate indications and contraindications. In addition, we will discuss the wide variety of catheter types available and their perceived advantages. There remains some debate with regard to gastropexy performance and the use of primary gastrojejunal catheters, which we will address. In addition, we will discuss the advantages and disadvantages of the three major types of gastrostomy placement currently available (i.e., surgical, endoscopic, and radiological) and their associated complications.

Advances in Gastrostomy Placement and Care in Children

“…As remarked earlier in this chapter the utility of such tubes is up for debate, however if one does wish to place such a tube the modifications to the technique above are not major and there is a relatively high success rate (Given et al 2005). …”

Updates on Percutaneous Radiologic Gastrostomy/Gastrojejunostomy and Jejunostomy

“…14,15 Gastrojejunostomy tubes are longer and narrower than those placed in the stomach, and this could result in more frequent complications, such as tube blockage. 16 …”

“…16 Other less common indications include small bowel decompression for obstruction. Percutaneous puncture of the jejunum is more difficult than that of stomach because of the high mobility and easy collapsibility of the jejunum.…”

“…Particular care should be taken to avoid overlying large bowel loops, and decompression of the colon might need to be performed prior to jejunostomy insertion. 16 Dilatation of jejunal loops is achieved by slow saline injection. Upon frontal and lateral fluoroscopy, the angiographic catheter tip is located in an air-filled proximal jejunal loop, as a target, in a portion that is sufficiently close to the anterior abdominal wall.…”

Percutaneous Endoscopic Gastrostomy in Neurological Patients

“…As an alternative to endoscopically-placed jejunostomy tubes, fluoroscopicallyguided catheters can be placed. Percutaneous radiologic gastrojejunostomy (PRGJ) involves a longer and narrower tube than that placed in the stomach, and is thought to carry the potential for more frequent complications, such as tube blockage; PRGJ can be considered as a conversion from gastrostomy or placed as a primary option (Given et al, 2005;Shin & Park, 2010;Hoffer et al, 1999). Percutaneous radiologic jejunostomy (PRJ) is indicated in patients whose stomach is inaccessible for gastrostomy placement, or in those who have had a previous gastrectomy (Given et al, 2005;Shin & Park, 2010).…”