Utility of pre-procedural CT and abdominal radiography before percutaneous radiologic gastrostomy placement

To evaluate the utility of pre-procedural CT and abdominal radiography before percutaneous radiologic gastrostomy tube placement.

A retrospective review of gastrostomy tube placements was conducted at a tertiary care radiology department. During the studied period, all percutaneous radiologic G-tube placements (PRG) at the institution required a pre-procedural abdominal CT. Whether the CT was interpreted to have an adequate window for PRG was recorded. The same patients with pre-procedural abdominal radiographs were also identified and retrospectively reviewed for the presence of satisfactory anatomy for PRG. Outcomes of tube placements were reviewed.

126 PRG requests were identified, all with abdominal CTs. 110 also had an abdominal radiograph. An adequate window for PRG was present in 83% of patients by CT and 73% by radiography. Of patients in whom it was attempted, 94% underwent successful PRG with a 7.4% minor complication rate. Of those refused for PRG based on CT, 9% had successful percutaneous endoscopic G-tube placement, resulting in a sensitivity of 98%. 97% of patients with satisfactory anatomy by radiograph underwent successful PRG. Of those with no window, 66% had a window by CT, and 94% in whom it was attempted had successful PRG placement. This resulted in a sensitivity of 77% for radiography. Concordance between CT and radiography was 73%.

Pre-procedural CT interpretation is highly predictive of successful and uncomplicated PRG. Abdominal radiography also predicts successful PRG, but with a lower accuracy, limiting its utility as a pre-procedural exam.