Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications.

Keywords:
Gastrostomy; Radiology, interventional; Tomography, X-ray computed

Authorship

Chiang Jeng Tyng

PhD, Attending Physician, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilPhD, Attending Physician, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

Erich Frank Vater Santos

MD, Radiologist, Resident in Interventional Radiology, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilMD, Radiologist, Resident in Interventional Radiology, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

Luiz Felipe Alves Guerra

MD, Resident in Radiology and Diagnostic Imaging, Hospital Universitário Cassiano Antonio de Morais - Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, ES, Brazil.Universidade Federal do Espírito SantoBrazilVitória, ES, BrazilMD, Resident in Radiology and Diagnostic Imaging, Hospital Universitário Cassiano Antonio de Morais - Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, ES, Brazil.

Almir Galvão Vieira Bitencourt Mailing address: Dr. Almir Galvão Vieira Bitencourt. A.C.Camargo Cancer Center - Departamento de Imagem. Rua Professor Antônio Prudente, 211, Liberdade. São Paulo, SP, Brazil, 01509-010. E-mail. almirgvb@yahoo.com.br.

Paula Nicole Vieira Pinto Barbosa

Rubens Chojniak

PhD, Head of the Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilPhD, Head of the Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

Mailing address: Dr. Almir Galvão Vieira Bitencourt. A.C.Camargo Cancer Center - Departamento de Imagem. Rua Professor Antônio Prudente, 211, Liberdade. São Paulo, SP, Brazil, 01509-010. E-mail. almirgvb@yahoo.com.br.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (6)

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Figure 1
Marking the puncture site for CT-guided percutaneous gastrostomy. Three-dimensional CT reconstruction shows the appropriate site for the puncture, at the anterior abdominal wall, lateral to the rectus abdominis muscle (circle in A). It is necessary to mark three equidistant points, 3-4 cm apart, forming a triangle (circle in B).

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Figure 2
Fixation of the gastric wall for CT-guided percutaneous gastrostomy. Introduction of the needle cannula at one of the points of the previously marked triangle (A). After the correct positioning has been confirmed (B), the gastric wall is fixed at this point (C,D). The same procedure is repeated at the two other points of the triangle.

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Figure 3
Gastric puncture for CT-guided percutaneous gastrostomy. A puncture needle is placed in the center of the previously established triangle (A) and the stomach is transfixed (B).

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Figure 4
Passage of the guidewire and dilators for CT-guided percutaneous gastrostomy. The guidewire is passed through the interior of the gastric puncture needle (A), after which the needle is withdrawn and the guidewire is used in order to introduce the dilators and the trocar (B,C), as shown on the CT scan (D).

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Figure 5
Introduction of the tube for the CT-guided percutaneous gastrostomy. The gastrostomy tube is passed through the trocar (A), and the balloon is inflated within the stomach (B).

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Figure 6
Final step of CT-guided percutaneous gastrostomy. After the correct positioning of the tube has been confirmed, it is fixed to the skin (A), and a follow-up CT is performed after gastric deflation (B)

Figure 1 Marking the puncture site for CT-guided percutaneous gastrostomy. Three-dimensional CT reconstruction shows the appropriate site for the puncture, at the anterior abdominal wall, lateral to the rectus abdominis muscle (circle in A). It is necessary to mark three equidistant points, 3-4 cm apart, forming a triangle (circle in B).

Figure 2 Fixation of the gastric wall for CT-guided percutaneous gastrostomy. Introduction of the needle cannula at one of the points of the previously marked triangle (A). After the correct positioning has been confirmed (B), the gastric wall is fixed at this point (C,D). The same procedure is repeated at the two other points of the triangle.

Figure 3 Gastric puncture for CT-guided percutaneous gastrostomy. A puncture needle is placed in the center of the previously established triangle (A) and the stomach is transfixed (B).

Figure 4 Passage of the guidewire and dilators for CT-guided percutaneous gastrostomy. The guidewire is passed through the interior of the gastric puncture needle (A), after which the needle is withdrawn and the guidewire is used in order to introduce the dilators and the trocar (B,C), as shown on the CT scan (D).

Figure 5 Introduction of the tube for the CT-guided percutaneous gastrostomy. The gastrostomy tube is passed through the trocar (A), and the balloon is inflated within the stomach (B).

Figure 6 Final step of CT-guided percutaneous gastrostomy. After the correct positioning of the tube has been confirmed, it is fixed to the skin (A), and a follow-up CT is performed after gastric deflation (B)

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Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

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[1] Mailing address: Dr. Almir Galvão Vieira Bitencourt. A.C.Camargo Cancer Center - Departamento de Imagem. Rua Professor Antônio Prudente, 211, Liberdade. São Paulo, SP, Brazil, 01509-010. E-mail. almirgvb@yahoo.com.br.