Image-guided percutaneous gastrostomy in neonates with esophageal atresia.
BACKGROUND
Neonates with esophageal atresia may require a gastrostomy before definitive repair. Most surgeons do this procedure using the Stamm technique through a laparotomy. The authors describe a new technique for percutaneous placement of a gastrostomy in these infants and report their preliminary results.


METHODS
For children with esophageal atresia and a tracheoesophageal fistula (TEF), the air-filled stomach is localized fluoroscopically and accessed using a standard percutaneous technique. For those with pure esophageal atresia, a transhepatic needle is used to instil air into the stomach. Once the stomach is distended, the gastrostomy tube is inserted under fluoroscopy.


RESULTS
Fourteen neonates with esophageal atresia had a percutaneous gastrostomy tube placed. Eleven had esophageal atresia and a TEF, and 3 had pure esophageal atresia with a gasless abdomen requiring the transhepatic approach. There were no intraoperative or major postoperative complications, but there were 5 minor early postoperative complications and 2 minor late postoperative complications.


CONCLUSIONS
Percutaneous gastrostomy insertion is a safe technique for neonates with esophageal atresia and can be used even in children with pure esophageal atresia who have a gasless abdomen. This technique does not require laparotomy and appears to be associated with a low rate of complications.
Aziz
Dalal
D
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Chait
Peter
P
Kreichman
Felix
F
Langer
Jacob C
JC
D004933:Esophageal Atresia / Q000601:surgery*; D005471:Fluoroscopy; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D014138:Tracheoesophageal Fistula / Q000150:complications