Percutaneous radiologic gastrostomy: results and analysis of factors contributing to complications

INTENT: Assessment of feasibility of percutaneous radiologic gastrostomy (PRG) for long- or short-term nutritional support and analysis of attendant complications and their underlying causes.

A retrospective analysis of outcome, complications, and their underlying causes was carried out in 391 patients who had percutaneous gastrostomies performed in two different university medical centers from January 2005 to April 2010 by interventional radiology. Forty-three were performed under general anesthesia and 348 were under local anesthesia and conscious sedation; in 349, fluoroscopic guidance was used, in 17 ultrasound, and in 22 CT.

Three hundred and seventy-six procedures were technically successful (96%). The procedure-related mortality was 2.5%. Fifty-seven gastrostomies were removed after clinical condition of the patients had improved. Only 36 gastrostomies remained functional for a year or longer. Major complications attributable to PRGs occurred in 6.1% (24 of 391) of our patients. On retrospective analysis, faulty technique may have been a major factor in many of these 24 patients. Injuries of abdominal organs and misplaced gastrostomies occasioned by improper localization of T fasteners were the major culprits. Minor complications occurred in 17.6% of patients.

Meticulous pre-procedural assessment of the topographic anatomy, preferably by CT, is mandatory to avoid or minimize by injury of colon, spleen, liver etc. Precise placement of T fasteners and confirmation of gastric access under cross-table lateral fluoroscopy is necessary for proper placement of the gastrostomy tube. Percutaneous radiologic gastrostomy has proven an excellent technique for short- and long-term nutritional support.