title: CT fluoroscopy guided percutaneous gastrostomy or jejunostomy without (CT-PG/PJ) or with simultaneous endoscopy (CT-PEG/PEJ) in otherwise untreatable patients.
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) are substantial for patients with swallowing disorders to maintain enteral nutrition or to decompress palliatively intractable small bowel obstruction. Endoscopic placement can be impossible due to previous (gastric) operation, obesity, hepato-splenomegaly, peritoneal carcinosis, inadequate transillumination, or obstructed passage. Computed tomography (CT)-fluoroscopic guidance with or without endoscopy can enable placement of CT-PG/CT-PJ or CT-PEG/CT-PEJ if endoscopically guided placement fails. In this retrospective study, we will evaluate the feasibility and safety of this method.
  
  
  METHODS
  A total of 101 consecutive patients were referred to our department for feeding support (n = 87) or decompression (n = 14). Reasons were: ENT tumor (n = 51), esophageal cancer (n = 19), mediastinal mass (n = 2), neurological disorder (n = 15). Decompression tubes were placed because of cancer (n = 13) or Crohn's disease (n = 1). The following approaches were chosen: CT fluoroscopy and simultaneous gastroscopy (n = 61), inflation of the stomach via nasogastric tube (n = 29), and direct puncture under CT-fluoroscopic guidance (n = 11).
  
  
  RESULTS
  CT fluoroscopy-guided gastrostomy was feasible in 89 of 101 patients. No procedure-related mortality was observed. One tube was misplaced into the colon in a patient with a history of gastrectomy. No complication was seen after removal. Minor complications: dislodgement (n = 17), peristomal leakage (n = 7), wound infection (n = 1), superficial skin infection (n = 6), tube obstruction (n = 2).
  
  
  CONCLUSIONS
  CT fluoroscopy-guided PG/PJ or PEG/PEJ is feasible and safe and provides adequate feeding support or decompression. It offers the benefits of minimally invasive therapy even in patients with contraindications to established endoscopic methods, combining the advantages of both techniques. Long-term complications-mainly tube-related problems-are easily treated.
authors.affiliation: Department of Surgery, Ludwig-Maximilians-University, Munich, Campus Grosshadern Marchioninistrasse 15, 81377, Munich, Germany. fritz.spelsberg@gmx.de
authors.forename: Fritz W
authors.initials: FW
authors.lastname: Spelsberg
authors.forename: Ralf-Thorsten
authors.initials: RT
authors.lastname: Hoffmann
authors.forename: Reinhold A
authors.initials: RA
authors.lastname: Lang
authors.forename: Hauke
authors.initials: H
authors.lastname: Winter
authors.forename: Rolf
authors.initials: R
authors.lastname: Weidenhagen
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.forename: Christoph
authors.initials: C
authors.lastname: Trumm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005773:Gastroscopy; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult