title: Radiologic Percutaneous Gastrostomy in Nondistended Stomach: A Modified Approach.
abstract: BACKGROUND
  Gastrostomy tube placement for patients requiring long-term nutritional support may be performed using different techniques including endoscopic, surgical, and percutaneous radiologically guided methods. Radiologically inserted gastrostomy (RIG), typically performed when percutaneous endoscopic gastrostomy is not possible, requires proper gastric distension that is achieved by insufflating air through a nasogastric tube. We describe a simple technique to prevent air escape from the stomach during gastrostomy tube placement. To the best of our knowledge, this technique has not yet been described in the literature.
  
  
  METHODS
  Four patients with unsuccessful percutaneous endoscopic gastrostomy were referred for fluoroscopic-guided gastrostomy. One patient had a pyriform sinus tumor and three had an ischemic stroke causing dysphagia. Gastric distention was not achieved in the patients due to air escaping into the bowel during the standard RIG procedure. A modified approach using a balloon catheter inflated in the pylorus to avoid air passing into the duodenum permitted successful RIG.
  
  
  RESULTS
  The modified RIG procedure was successfully carried out in all cases without complications.
  
  
  CONCLUSIONS
  Inadequate air distension of the stomach is an unusual event that causes a failure of gastrostomy tube placement and an increased risk of both major and minor complications. The use of a balloon catheter inflated in the first part of the duodenum prevents the air passage into the bowel allowing the correct positioning of the gastrostomy.
authors.affiliation: Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy. francesco.petrocelli@hsanmartino.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Petrocelli
authors.affiliation: Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Salsano
authors.affiliation: Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Bovio
authors.affiliation: Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Camerano
authors.affiliation: Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Utili
authors.affiliation: Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ferro
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Balloon catheter; Enteral nutrition; Gastropexy; Gastrostomy