CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S12
DOI: 10.1055/s-0041-1730678
Abstract

Percutaneous Endoscopic Gastrostomy Large-Bore Tube Application without the Use of Endoscope: Single-Center Experience on 86 Neurologically Compromised Patients

Rana Tarek Mohamed Khafagy
Ain Shams University Hospital, Cairo, Egypt
,
Karim Abd El-Tawab
Ain Shams University Hospital, Cairo, Egypt
› Author Affiliations

Background: Despite being an established method of enteral feeding, percutaneous fluoroscopic-guided small-bore push gastrostomy tubes are more prone to tube occlusion and dislodgement. This study describes an adapted alternative of nonendoscopic technique to apply large-bore mushroom-head gastrostomy tubes originally designed to be applied endoscopically. Methods: Between January 2015 and November 2017, 86 gastrostomy tubes were placed in 86 neurologically compromised patients. 24F mushroom-head tubes were used. The stomach was filled with air via nasogastric tube through which a Dormia basket or a large Snare was introduced. A 16G Angiocath was advanced through a skin puncture into the Dormia basket at the gastric body level through which bifid guidewire was extracted by the Dormia basket or the snare. The gastrostomy tube was bound to the wire and pulled under fluoroscopic guidance. Technical success and procedural complications were assessed and regular follow-up was done to ensure tube function and monitor complications. Results: A 100% technical success was achieved defined as successful positioning of the stent, bypassing the leakage. Distal migration occurred twice in the same patient with balloon repositioning. Persistence of the leakage after stent removal took place in four patients (all were referred late 20 days plus postsurgery), three of which had re-surgery and one patient who had residual tubular cutaneous-anastomosis fistula had track coiling with cessation of leakage. Conclusion: Fluoroscopic-guided esophageal stenting might be effective in bypassing anastomotic leakages following bariatric surgeries; however, it should be considered as soon as significant leakage is diagnosed and should be considered before re-surgery. Placement of the stents was feasible without major procedure-related complications.



Publication History

Article published online:
11 May 2021

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