Gastrostomy With CT-Fluoroscopic Guidance

Abstract

Percutaneous endoscopic and fluoroscopic gastrostomy are preferred over surgical gastrostomy because they are safer and less expensive. However, these methods sometimes fail due to inability to find a safe percutaneous path to the stomach. Computed tomography (CT) has been used to guide safe puncture in such difficult cases, but because it is slow and tedious, it is seldom used routinely for gastrostomy. Continuous imaging CT (CTF) combines the safety inherent in the three-dimensional resolution of CT with the speed and real-time feedback of fluoroscopy. After insufflating the stomach, directed helical CT is used to find a suitable window for percutaneous entry. Under CT fluoroscopy (CTF) guidance, a Cope anchor set (Cook, Bloomington, IN) is used to access the stomach and perform gastropexy. Serial dilatation and tube placement are done with intermittent CTF. Tube position is confirmed by injection of dilute contrast. In our experience, CTF has been quick, effective and well tolerated in all patients, extending the range of gastrostomies that can be performed percutaneously without increasing time or difficulty of the procedure.

Keywords:

Gastrostomy - CT fluoroscopy - drainage