Semin intervent Radiol 2019; 36(03): 264-274
DOI: 10.1055/s-0039-1693983
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Gastrostomy Tube Placement: Recognizing When Things Go Wrong

Peter T. Hoang
1   Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, Arizona
,
Christine O. Menias
2   Division of Abdominal Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona
,
Matthew M. Niemeyer
3   Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

Publication Date:
19 August 2019 (online)

Abstract

Percutaneous radiologic gastrostomy is a commonly performed, minimally invasive procedure for long-term enteral access in patients with a variety of conditions. Compared with other methods, it is less invasive, less costly, and safe, with a high technical success rate. The risk of complications is low, and most require only conservative management. Early, accurate diagnosis of more severe complication is crucial, as these may require prompt intervention. Therefore, radiologists should understand the imaging features, clinical presentation, and management of gastrostomy-related complications. This article will review the indications for long-term enteral access, discuss the available methods, summarize the percutaneous radiologic technique, and highlight the associated complications from gastrostomy placement.

IRB Approval

No IRB approval was required.


 
  • References

  • 1 Itkin M, DeLegge MH, Fang JC. , et al; Interventional Radiology and American Gastroenterological Association; 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). J Vasc Interv Radiol 2011; 22 (08) 1089-1106
  • 2 Patel IJ, Davidson JC, Nikolic B. , et al; Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23 (06) 727-736
  • 3 Eisen GM, Baron TH, Dominitz JA. , et al; American Society for Gastrointestinal Endoscopy. Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastrointest Endosc 2002; 55 (07) 775-779
  • 4 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
  • 5 Gassas A, Kennedy J, Green G. , et al. Risk of ventriculoperitoneal shunt infections due to gastrostomy feeding tube insertion in pediatric patients with brain tumors. Pediatr Neurosurg 2006; 42 (02) 95-99
  • 6 Artul S, Nseir W, Assaf V, Abboud N. Abdominal wall necrotising fasciitis due to dislodged percutaneous endoscopic gastrostomy tube. BMJ Case Rep 2014; 2014: pii: bcr2013201346
  • 7 Ingraham C, Albrecht E, Johnson G. , et al. Antibiotic prophylaxis for percutaneous gastrostomy: a double-blind, randomized placebo-controlled, prospective trial. J Vasc Interv Radiol 2016; 27: S40-S41
  • 8 Grant DG, Bradley PT, Pothier DD. , et al. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 2009; 34 (02) 103-112
  • 9 Beaver ME, Myers JN, Griffenberg L, Waugh K. Percutaneous fluoroscopic gastrostomy tube placement in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 1998; 124 (10) 1141-1144
  • 10 Allen JA, Chen R, Ajroud-Driss S. , et al. Gastrostomy tube placement by endoscopy versus radiologic methods in patients with ALS: a retrospective study of complications and outcome. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14 (04) 308-314
  • 11 Ho CS, Gray RR, Goldfinger M, Rosen IE, McPherson R. Percutaneous gastrostomy for enteral feeding. Radiology 1985; 156 (02) 349-351
  • 12 Wills JS, Oglesby JT. Percutaneous gastrostomy. Radiology 1983; 149 (02) 449-453
  • 13 Khalilzadeh O, Baerlocher MO, Shyn PB. , et al. Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 2017; 28 (10) 1432-1437.e3
  • 14 Wysoki MG, Santora TA, Shah RM, Friedman AC. Necrotizing fasciitis: CT characteristics. Radiology 1997; 203 (03) 859-863
  • 15 Zacharias N, Velmahos GC, Salama A. , et al. Diagnosis of necrotizing soft tissue infections by computed tomography. Arch Surg 2010; 145 (05) 452-455
  • 16 Perona F, Castellazzi G, De Iuliis A, Rizzo L. Percutaneous radiologic gastrostomy: a 12-year series. Gut Liver 2010; 4 (Suppl. 01) S44-S49
  • 17 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
  • 18 Greif JM, Ragland JJ, Ochsner MG, Riding R. Fatal necrotizing fasciitis complicating percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986; 32 (04) 292-294
  • 19 Person JL, Brower RA. Necrotizing fasciitis/myositis following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986; 32 (04) 309
  • 20 Haslam N, Hughes S, Harrison RF. Peritoneal leakage of gastric contents, a rare complication of percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr 1996; 20 (06) 433-434
  • 21 Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987; 93 (01) 48-52
  • 22 Covarrubias DA, O'Connor OJ, McDermott S, Arellano RS. Radiologic percutaneous gastrostomy: review of potential complications and approach to managing the unexpected outcome. AJR Am J Roentgenol 2013; 200 (04) 921-931
  • 23 Carr WR, Mohamed ZK, Cundall J. Rupture of an inferior epigastric artery pseudo-aneurysm following laparoscopic port insertion. BMJ Case Rep 2012; 2012: pii: bcr0220125867
  • 24 Gage TS, Sussman SK, Conard III FU, Hull D, Bartus SA. Pseudoaneurysm of the inferior epigastric artery: diagnosis and percutaneous treatment. AJR Am J Roentgenol 1990; 155 (03) 529-530
  • 25 Edwards KJ, Avula SK, Babu BD, England RA. Inferior epigastric artery pseudoaneurysms. Ann R Coll Surg Engl 2015; 97 (04) 255-258
  • 26 Shabani AG, Baxter GM. Inferior epigastric artery pseudoaneurysm: ultrasound diagnosis and treatment with percutaneous thrombin. Br J Radiol 2002; 75 (896) 689-691
  • 27 Seo N, Shin JH, Ko G-Y. , et al. Incidence and management of bleeding complications following percutaneous radiologic gastrostomy. Korean J Radiol 2012; 13 (02) 174-181
  • 28 Smale E, Davison AM, Smith M. , et al. Fatal intra-abdominal haemorrhage following percutaneous endoscopic gastrostomy. BMJ Case Rep 2009 2009. Doi: 10.1136/bcr.06.2009.2044. [Epub August 19, 2009]
  • 29 Lee JY, Park KS. Pneumoperitoneum after percutaneous endoscopic gastrostomy: does it have clinical significance?. Intest Res 2015; 13 (04) 295-296
  • 30 Milanchi S, Allins A. Early pneumoperitoneum after percutaneous endoscopic gastrostomy in intensive care patients: sign of possible bowel injury. Am J Crit Care 2007; 16 (02) 132-136
  • 31 Park WY, Lee TH, Lee JS. , et al. Reappraisal of pneumoperitoneum after percutaneous endoscopic gastrostomy. Intest Res 2015; 13 (04) 313-317
  • 32 Chhaparia A, Hammami MB, Bassuner J, Hachem C. Trans-hepatic percutaneous endoscopic gastrostomy tube placement: a case report of a rare complication and literature review. Gastroenterol Res 2018; 11 (02) 145-149
  • 33 Gubler C, Wildi SM, Bauerfeind P. Liver injury during PEG tube placement: report of two cases. Gastrointest Endosc 2005; 61 (02) 346-348
  • 34 Tam A, Wagner-Bartak NA, Wallace MJ, Murthy R. Liver abscess after inadvertent transhepatic transgression during percutaneous fluoroscopy-guided gastrostomy. Clin Radiol 2008; 63 (06) 731-735
  • 35 Rafiq A, Abbas N, Tariq H, Nayudu SK. Gastro-hepatic fistula with liver abscess: a rare complication of a common procedure. Am J Case Rep 2015; 16: 652-657
  • 36 Miller FJ, Ahola DT, Bretzman PA, Fillmore DJ. Percutaneous management of hepatic abscess: a perspective by interventional radiologists. J Vasc Interv Radiol 1997; 8 (02) 241-247
  • 37 Pearce NW, Knight R, Irving H. , et al. Non-operative management of pyogenic liver abscess. HPB (Oxford) 2003; 5 (02) 91-95
  • 38 Christein JD, Kendrick ML, Que FG. What affects mortality after the operative management of hepatic abscess?. HPB (Oxford) 2006; 8 (03) 175-178
  • 39 Burke DT, Geller AI, Carayannopoulos AG, Goldstein R. Inadvertent percutaneous endoscopic gastrostomy tube placement through the transverse colon to the stomach causing intractable diarrhea: a case report. Diagn Ther Endosc 2011; 2011: 849460
  • 40 Funaki B. Transcolonic gastrostomy catheter managed conservatively. Semin Intervent Radiol 2010; 27 (03) 320-324
  • 41 Shah AM, Shah N, DePasquale JR. Replacement gastrostomy tube causing acute pancreatitis: case series with review of literature. JOP 2012; 13 (01) 54-57
  • 42 Geer W, Jeanmonod R. Early presentation of buried bumper syndrome. West J Emerg Med 2013; 14 (05) 421-423
  • 43 Cyrany J, Rejchrt S, Kopacova M, Bures J. Buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy. World J Gastroenterol 2016; 22 (02) 618-627
  • 44 Libânio D, Pimentel-Nunes P. Early buried bumper syndrome - to leave or not to leave. GE Port J Gastroenterol 2018; 25 (03) 115-116