Percutaneous Radiologic Gastrostomy Tube Placement Techniques

Abstract

Gastrostomy tubes are a common procedure for interventional radiologists. Several techniques are available to obtain gastric access radiologically, including the antegrade, retrograde, and balloon-assisted techniques. The choice of technique can depend on the patient's clinical presentation and the available services at each institution. Indications, preprocedural workup, technique, and postprocedural care help guide the choice of approach. Three common methods will be reviewed in this article: antegrade, retrograde, and balloon assisted. The antegrade technique is comparable to percutaneous endoscopic gastrostomy placement with a decreased incidence of tube dislodgement compared to the retrograde technique, but it requires reliable oral and esophageal access. The retrograde technique reduces the risk of postprocedural infection, has shorter procedure times, and reduces radiation exposure. The balloon-assisted technique reduces procedure time even more than the antegrade or retrograde technique, with comparable outcomes. Understanding the most common techniques available and how they compare is essential to providing patient-centered care.

Keywords

enteral feeding - gastrostomy - fluoroscopic guidance - interventional radiology - technique

Publication History

Article published online:
31 March 2025

• References

• 1 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
• 2 Gauderer MWL, Ponsky JL, Izant Jr RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15 (06) 872-875
• 3 Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg 2022; 14 (04) 286-303
• 4 Preshaw RM. A percutaneous method for inserting a feeding gastrostomy tube. Surg Gynecol Obstet 1981; 152 (05) 658-660
• 5 Thaker AM, Sedarat A. Laparoscopic-assisted percutaneous endoscopic gastrostomy. Curr Gastroenterol Rep 2016; 18 (09) 46
• 6 Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014; 20 (24) 7739-7751
• 7 Gutjahr CJ, Iverson EP, Walker ST, Johnson JD, Shukla UC, Terrell W. Utility of pre-procedural CT and abdominal radiography before percutaneous radiologic gastrostomy placement. Abdom Radiol (NY) 2020; 45 (02) 571-575
• 8 Zopf Y, Maiss J, Konturek P, Rabe C, Hahn EG, Schwab D. Predictive factors of mortality after PEG insertion: guidance for clinical practice. JPEN J Parenter Enteral Nutr 2011; 35 (01) 50-55
• 9 Tominaga N, Shimoda R, Iwakiri R. et al. Low serum albumin level is risk factor for patients with percutaneous endoscopic gastrostomy. Intern Med 2010; 49 (21) 2283-2288
• 10 Metheny NA, Meert KL, Clouse RE. Complications related to feeding tube placement. Curr Opin Gastroenterol 2007; 23 (02) 178-182
• 11 Lai PB, Pang PC, Chan SK, Lau WY. Necrosis of the nasal ala after improper taping of a nasogastric tube. Int J Clin Pract 2001; 55 (02) 145
• 12 Motta APG, Rigobello MCG, Silveira RCCP, Gimenes FRE. Nasogastric/nasoenteric tube-related adverse events: an integrative review. Rev Lat Am Enfermagem 2021; 29: e3400
• 13 Tsukuda T, Fujita T, Ito K, Yamashita T, Matsunaga N. Percutaneous radiologic gastrostomy using push-type gastrostomy tubes with CT and fluoroscopic guidance. AJR Am J Roentgenol 2006; 186 (02) 574-576
• 14 Hoang PT, Menias CO, Niemeyer MM. Percutaneous gastrostomy tube placement: recognizing when things go wrong. Semin Intervent Radiol 2019; 36 (03) 264-274
• 15 Jaffe TA, Raiff D, Ho LM, Kim CY. Management of anticoagulant and antiplatelet medications in adults undergoing percutaneous interventions. AJR Am J Roentgenol 2015; 205 (02) 421-428
• 16 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions - Part II: Recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
• 17 Lau JYW, Yu Y, Tang RSY. et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med 2020; 382 (14) 1299-1308
• 18 Chehab MA, Thakor AS, Tulin-Silver S. et al. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology Practice Parameter update endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29 (11) 1483-1501.e2
• 19 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
• 20 Vidhya C, Phoebe D, Dhina C, Jayne S, Robert F. Percutaneous endoscopic gastrostomy (PEG) versus radiologically inserted gastrostomy (RIG): a comparison of outcomes at an Australian teaching hospital. Clin Nutr ESPEN 2018; 23: 136-140
• 21 Bernstein OA, Campbell J, Rajan DK. et al. Randomized trial comparing radiologic pigtail gastrostomy and peroral image-guided gastrostomy: intra- and postprocedural pain, radiation exposure, complications, and quality of life. J Vasc Interv Radiol 2015; 26 (11) 1680-1686 , quiz 1686
• 22 Galaski A, Peng WW, Ellis M, Darling P, Common A, Tucker E. Gastrostomy tube placement by radiological versus endoscopic methods in an acute care setting: a retrospective review of frequency, indications, complications and outcomes. Can J Gastroenterol 2009; 23 (02) 109-114
• 23 Inaba Y, Yamaura H, Sato Y. et al. Percutaneous radiologic gastrostomy in patients with malignant pharyngoesophageal obstruction. Jpn J Clin Oncol 2013; 43 (07) 713-718
• 24 Haber ZM, Charles HW, Gross JS, Pflager D, Deipolyi AR. Percutaneous radiologically guided gastrostomy tube placement: comparison of antegrade transoral and retrograde transabdominal approaches. Diagn Interv Radiol 2017; 23 (01) 55-60
• 25 Lee S, Ghosh A, Raymond A, Akhter NM. A comparison of balloon-assisted versus dilator in percutaneous gastrostomy tube placement. J Clin Imaging Sci 2023; 13 (01) 25
• 26 Reis SP, Brejt SZ, Weintraub JR, Ahmad N, Susman J, Mobley DG. Percutaneous ultrasound guided gastrostomy tube placement: a prospective cohort trial. J Intensive Care Med 2022; 37 (05) 641-646
• 27 Yasin JT, Schuchardt PA, Atkins N. et al. CT-guided gastrostomy tube placement-a single center case series. Diagn Interv Radiol 2020; 26 (05) 464-469
• 28 Tamura A, Kato K, Suzuki M. et al. CT-guided percutaneous radiologic gastrostomy for patients with head and neck cancer: a retrospective evaluation in 177 patients. Cardiovasc Intervent Radiol 2016; 39 (02) 271-278
• 29 Black MT, Hung CA, Loh C. Subcutaneous T-fastener gastropexy: a new technique. AJR Am J Roentgenol 2013; 200 (05) 1157-1159
• 30 Bechtold ML, Matteson ML, Choudhary A, Puli SR, Jiang PP, Roy PK. Early versus delayed feeding after placement of a percutaneous endoscopic gastrostomy: a meta-analysis. Am J Gastroenterol 2008; 103 (11) 2919-2924
• 31 Huang SY, Engstrom BI, Lungren MP, Kim CY. Management of dysfunctional catheters and tubes inserted by interventional radiology. Semin Intervent Radiol 2015; 32 (02) 67-77