Cone-beam computed tomography-guided percutaneous radiologic gastrostomy

Area of Science:

• Radiology
• Gastroenterology
• Medical Imaging

Background:

• Percutaneous endoscopic gastrostomy (PEG) is a common procedure for enteral feeding.
• PEG may fail or be unsuitable in cases of upper gastrointestinal obstruction, often due to malignancies.

Purpose of the Study:

• To evaluate the feasibility of using flat-detector C-arm cone-beam computed tomography (CBCT) for percutaneous radiologic gastrostomy (PRG) insertion.
• To assess the safety and efficacy of CBCT-guided PRG in patients unsuitable for PEG.

Main Methods:

• Eighteen patients with failed or unsuitable PEG underwent CBCT-guided PRG.
• Initial C-arm CBCT scans were acquired, followed by 2D/3D soft-tissue reconstructions.
• Gastropexy and catheter insertion were performed under CBCT guidance.

Main Results:

• Technical success was achieved in all 18 patients without intraprocedural complications.
• Minor complications (1 PRG malfunction, 1 infection) occurred in 2 patients within 30 days.
• Late complications (tube disturbances) were observed in 2 patients; mean follow-up was 212 days.

Conclusions:

• CBCT-guided PRG is a safe, well-tolerated, and effective gastrostomy method when PEG is not feasible.
• CBCT provides detailed epigastric imaging, enhancing PRG procedure planning and execution.