Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
PERCUTANEOUS GASTROSTOMY: INDICATIONS, TECHNIQUES, AND COMPLICATIONS
Gastrointestinal Radiology Reviews. Volume 1. Herlinger H and Megibow A, eds. New York, Marcel Dekker, p. 15-24, 1990.. Unique Identifier : AIDSLINE ICDB/92668996 Ho CS; Yee AC; Dept. of Radiology, Toronto General Hosp., Toronto, Ontario,; Canada
Abstract:
In 1983, several radiologists independently described a nonendoscopic method of percutaneous gastrostomy using the Seldinger technique under fluoroscopic control. The technique, indications, complications, and related aspects of this type of percutaneous gastrostomy are reviewed. The major indication for percutaneous gastrostomy is dysphagia leading to a negative nutritional balance. In most patients (pts), dysphagia is caused by a neurologic deficit, by tumors of the head and neck, and less often by esophageal malignancy. Occasionally, percutaneous gastrostomy is performed on pts with impaired appetite but without swallowing difficulty. Percutaneous nonendoscopic gastrostomy is performed only if the distended stomach is situated below the costal margin and there is no interposition of liver or colon between the stomach and the anterior abdominal wall. Technical modifications of the procedure include intragastric balloon support and fixation of the anterior gastric wall by nylon T-fasteners. Ip leakage of gastric contents after percutaneous gastrostomy has occurred once in 200 pts in the authors' experience. As with any feeding tube, blockage by nutrients and dislodgement are often encountered in percutaneous gastrostomy. These should be considered problems of nursing care, rather than complications, and are largely avoidable. It is generally accepted that percutaneous gastrostomy by either endoscopic or radiologic technique is preferred to surgery, because general anesthesia is avoided. The morbidity of the two techniques is comparable according to published data. While the endoscopic technique remains a simple gastrostomy, the radiologic method has evolved into a jejunostomy, since the feeding tube is advanced from the stomach into the small intestine. Within a few years after its introduction, the radiologic technique of percutaneous gastrostomy has been accepted in many centers as a preferred method for long-term enteral nutrition. The authors foresee further technical refinements and a growing role for this technique in clinical nutrition. (21 Refs)
Keywords: Acquired Immunodeficiency Syndrome/THERAPY Cachexia/*THERAPY Deglutition Disorders/*THERAPY Enteral Nutrition/INSTRUMENTATION/*METHODS Esophageal Neoplasms/THERAPY Fluoroscopy Gastrostomy/INSTRUMENTATION/*METHODS Head and Neck Neoplasms/THERAPY Human Neoplasms/*THERAPY MONOGRAPH REVIEW 921230
M92C5384
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Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
