Download PDF
Semin intervent Radiol 2025; 42(01): 017-021
DOI: 10.1055/s-0045-1805046
Review Article

Percutaneous Radiologic Gastrostomy Placement in Challenging Clinical Scenarios

Ian Ikeda
1   Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut
,
Robert Kleven
1   Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut
,
Joshua Cornman-Homonoff 
1   Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Percutaneous radiologic gastrostomy is indicated for patients who require enteral access for nutritional support, medication administration, and/or decompression. Some patients have comorbidities that increase procedural risk and may require deviation from the conventional approach, such as upper gastrointestinal tract obstruction, ascites, and postsurgical anatomy. In such cases, technical modifications and/or changes to the standard approach may be needed. This review describes several specific scenarios that require special consideration, focusing on clinical management options, risk mitigation techniques, and supportive evidence.

Keywords

percutaneous radiologic gastrostomy - upper GI obstruction - ascites - postsurgical anatomy - interventional radiology


Publication History

Article published online:
31 March 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jiang XY, Bertrand AS, Li G. et al. CT-guided percutaneous gastrostomy without preliminary placement of a nasogastric tube. J Vasc Interv Radiol 2019; 30 (06) 915-917
    Search in Google Scholar
  • 2 Yi J, Hong H, Kim M, Chung E. Abstract No. 701: Percutaneous radiologic gastrostomy/gastrojejunostomy placement without nasogastric access: US-guided gastric puncture technique and evaluation of feasibility and safety. J Vasc Interv Radiol 2018; 29: S288
    Search in Google Scholar
  • 3 Pugash RA, Brady AP, Isaacson S. Ultrasound guidance in percutaneous gastrostomy and gastrojejunostomy. Can Assoc Radiol J 1995; 46 (03) 196-198
    Search in Google Scholar
  • 4 Heberlein WE, Goodwin WJ, Wood CE, Yousaf M, Culp WC. Gastrostomy tube placement without nasogastric tube: a retrospective evaluation in 85 patients. Cardiovasc Intervent Radiol 2012; 35 (06) 1433-1438
    Search in Google Scholar
  • 5 Chan SC, Chu WC, Liu KW, Liao CT, Lee TS, Ng SH. Modified radiology-guided percutaneous gastrostomy (MRPG) for patients with complete obstruction of the upper digestive tract and who are without endoscopic or nasogastric access. Korean J Radiol 2011; 12 (02) 216-219
    Search in Google Scholar
  • 6 Itkin M, DeLegge MH, Fang JC. et al; Society of Interventional Radiology, American Gastroenterological Association Institute, Canadian Interventional Radiological Association, Cardiovascular and Interventional Radiological Society of Europe. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Gastroenterology 2011; 141 (02) 742-765
    Search in Google Scholar
  • 7 Kowalik KJ, Golzarian J, Hunter DW. Abstract No. 241: “Inside-out” gastrostomy tube placement for patients with ascites. J Vasc Interv Radiol 2009; 20: S92-S93
    Search in Google Scholar
  • 8 Cherian P, Blake C, Appleyard M, Clouston J, Mott N. Outcomes of radiologically inserted gastrostomy versus percutaneous endoscopic gastrostomy. J Med Imaging Radiat Oncol 2019; 63 (05) 610-616
    Search in Google Scholar
  • 9 Kohli DR, Kennedy KF, Desai M, Sharma P. Safety of endoscopic gastrostomy tube placement compared with radiologic or surgical gastrostomy: nationwide inpatient assessment. Gastrointest Endosc 2021; 93 (05) 1077-1085.e1
    Search in Google Scholar
  • 10 Ryan JM, Hahn PF, Mueller PR. Performing radiologic gastrostomy or gastrojejunostomy in patients with malignant ascites. AJR Am J Roentgenol 1998; 171 (04) 1003-1006
    Search in Google Scholar
  • 11 Shaw C, Bassett RL, Fox PS. et al. Palliative venting gastrostomy in patients with malignant bowel obstruction and ascites. Ann Surg Oncol 2013; 20 (02) 497-505
    Search in Google Scholar
  • 12 Deshmukh AP, Ali R, Madoff DC, Silin D, Zuckerman DA, Cornman-Homonoff J. Bowel injury during percutaneous radiologic gastrostomy tube placement: a case series. J Vasc Interv Radiol 2023; 34 (08) 1462-1465
    Search in Google Scholar
  • 13 Stevens SD, Picus D, Hicks ME, Darcy MD, Vesely TM, Kleinhoffer MA. Percutaneous gastrostomy and gastrojejunostomy after gastric surgery. J Vasc Interv Radiol 1992; 3 (04) 679-683
    Search in Google Scholar
  • 14 Itou C, Arai Y, Sone M, Sugawara S, Onishi Y, Kimura S. Percutaneous radiologic gastrostomy in patients after partial gastrectomy: a retrospective study to assess the technical feasibility of postsurgical remnant stomach access. Cardiovasc Intervent Radiol 2022; 45 (08) 1214-1224
    Search in Google Scholar
  • 15 Nosher JL, Bodner LJ, Girgis WS, Brolin R, Siegel RL, Gribbin C. Percutaneous gastrostomy for treating dilatation of the bypassed stomach after bariatric surgery for morbid obesity. AJR Am J Roentgenol 2004; 183 (05) 1431-1435
    Search in Google Scholar
  • 16 Stein EG, Cynamon J, Katzman MJ. et al. Percutaneous gastrostomy of the excluded gastric segment after Roux-en-Y gastric bypass surgery. J Vasc Interv Radiol 2007; 18 (07) 914-919
    Search in Google Scholar