Radiological Gastrostomy

Background and indications

Percutaneous radiologic gastrostomy (PRG) is placement of a feeding tube directly into the stomach percutaneously under fluoroscopic guidance. It is indicated for long-term enteral feeding (> 4-6 weeks) in patients with swallowing disorders (stroke, neurodegenerative diseases — ALS, Parkinson's, dementia), obstructive ENT/esophageal cancers, or gastric decompression (non-operable upper GI obstruction).

PRG is an alternative to endoscopic gastrostomy (PEG — percutaneous endoscopic gastrostomy), particularly when endoscopy is impossible (impassable esophageal stenosis, post-surgical anatomy).

Pre-procedure assessment

Assessment includes abdominal CT (stomach position, colon interposition, ascites), nutritional assessment, coagulation panel, and general condition and prognosis evaluation (gastrostomy should not be offered if life expectancy is too limited).

Procedure

Under local anesthesia and light sedation, the stomach is distended by air insufflation via nasogastric tube or effervescent granule administration. Under fluoroscopic guidance, 3-4 gastropexy anchors (T-fasteners) are inserted through the abdominal wall into the gastric wall to fix the stomach to the abdominal wall. A gastrostomy catheter (12-16F) is then inserted into the stomach percutaneously (Seldinger technique). The procedure takes 30-45 minutes.

Results and scientific evidence

Technical success rate is 95-99%. Major complication rate (1-4%) is comparable or lower than endoscopic PEG. PRG can be performed in patients where PEG is technically impossible. Enteral nutrition via gastrostomy significantly improves nutritional status and quality of life compared to long-term nasogastric tube.

Risks and complications

Peristomal infection (5-10%, reduced by antibiotic prophylaxis), peristomal leak (5-10%, mainly first days), tube displacement (5-10%), peritonitis (< 1%), hemorrhage (< 1%). Buried bumper syndrome is rare with radiologic technique.

Recovery

Feeding started 4-6 hours after placement (progressively). T-fasteners removed at 2-3 weeks. Tube change every 3-6 months.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by an interventional radiologist, in coordination with the gastroenterologist, nutritionist, and primary care physician.