title: Radiological insertion of gastrostomy in patients in whom endoscopy was unsuccessful.
abstract: BACKGROUND
  Endoscopy is the standard technique of percutaneous gastrostomy placement, but failure of placement may occur due to difficulty with intubation or previous abdominal surgery. A review of personal experience is made.
  
  
  METHODS
  Between January 1997 and May 1998, 90 gastrostomy devices were successfully placed endoscopically in our unit. Endoscopic placement was unsuccessful in 3 patients and not attempted in a further 7 because of oro-pharyngeal obstruction. These 10 patients (6 male, 4 female, aged 51-84 years) had advanced neuro-degenerative disease or malignancy of the head and neck or oesophagus. All patients underwent radiological insertion of a gastrostomy tube by the 'push' method after insufflation of air into the stomach via a naso-gastric tube.
  
  
  RESULTS
  Radiological insertion of gastrostomy device was successful in 9 out of 10 patients. Failure occurred in 1 patient due to inability to pass a naso-gastric tube and surgical gastrostomy was required. Pain at the gastrostomy site was the most common problem post-procedure and 4 patients still required analgesia on discharge. One patient developed a wound infection. There were no procedure-related deaths. The 30-day mortality due to all causes was 20%. Only 1 patient remained alive at 6 months.
  
  
  CONCLUSIONS
  Availability of a radiologist trained in the placement of percutaneous gastrostomy allowed 99% of such devices to be placed percutaneously, even in those patients in whom endoscopy was not possible. However advanced underlying disease in this patient group results in a high mortality.
authors.affiliation: Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. agshand@hotmail.com
authors.forename: A G
authors.initials: AG
authors.lastname: Shand
authors.forename: S R
authors.initials: SR
authors.lastname: Wild
authors.forename: D C
authors.initials: DC
authors.lastname: Grieve
authors.forename: J
authors.initials: J
authors.lastname: Evans
authors.forename: J
authors.initials: J
authors.lastname: Pendlebury
authors.forename: S
authors.initials: S
authors.lastname: Ghosh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D005774:Gastrostomy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D017211:Treatment Failure