Adjunctive techniques for percutaneous enteral access in children: a pictorial review

Area of Science:

• Pediatric Interventional Radiology
• Medical Imaging
• Gastroenterology

Background:

• Percutaneous gastrostomy and gastrojejunostomy tube placements are essential pediatric procedures.
• Smaller patient size and anatomical variations present unique challenges in pediatric cases.
• Limited percutaneous gastric access windows can complicate these procedures.

Purpose of the Study:

• To review and highlight adjunctive techniques for safe percutaneous gastroenteric tube placement in pediatric patients.
• To address challenges associated with pediatric patient anatomy and procedural access.
• To enhance operator confidence and success rates in primary percutaneous tube placements.

Main Methods:

• Review of adjunctive techniques including cone beam CT, needle decompression, balloon occlusion, and ultrasound-guided gastric puncture.
• Utilizing intra-gastric contrast-enhanced ultrasound (ceUS) to delineate gastric and abdominal wall relationships.
• Discussion of antegrade and retrograde techniques in the context of pediatric challenges.

Main Results:

• Adjunctive techniques can facilitate safe percutaneous access, especially with limited gastric access windows.
• Specific methods like cone beam CT and ultrasound offer improved visualization and guidance.
• These techniques can overcome anatomical variations and patient size limitations.

Conclusions:

• Adjunctive techniques are valuable for increasing the success of primary percutaneous gastroenteric tube placements in children.
• Improved operator confidence and procedural safety are key benefits of employing these methods.
• These strategies help manage challenges posed by pediatric anatomy and patient size.