title: CIRSE Standards of Practice Guidelines on Gastrostomy.
abstract: OBJECTIVE
  Surgical Gastrostomy has been around since the 19th century but in 1980 the first successful percutaneous endoscopic gastrostomy was reported. A year later the first successful percutaneous gastrostomy was performed using fluoroscopic guidance. The technique for percutaneous insertion and the equipment used has been refined since then and it is now considered the gold standard for gastrostomy insertion. Here we present guidelines for image-guided enteral feeding tubes in adults.
  
  
  METHODS
  We performed a review and analysis of the scientific literature, other national and international guidelines and expert opinion.
  
  
  RESULTS
  Studies have shown fluoroscopic techniques have consistently higher success rates with lower rates of major complications than endoscopic techniques. However, the Achilles' heel of many fluoroscopic techniques is the requirement for smaller gastrostomy tube sizes resulting in them being more prone to blockages and thus requiring further intervention.
  
  
  CONCLUSIONS
  Radiological feeding tube insertion is a safe and effective procedure. Success rates are higher, and complication rates lower than PEG or surgical gastrostomy tube placement and innovative techniques for gastric and jejunal access mean that there are very few cases in which RIG is not possible. The principal weakness of radiologically inserted gastrostomies is the limitiation on tube size which leads to a higher rate of tube blockage. Per-oral image-guided gastrostomies have to an extent addressed this but have not been popularised. Currently many centres still consider endoscopic gastrostomies as the first line unless patients are too unwell to undergo this procedure or previous attempts have failed, in which case radioloically inserted gastrostomies are the technique of choice.
authors.affiliation: Radiology Department, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: James
authors.initials: J
authors.lastname: Sutcliffe
authors.affiliation: Radiology Department, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wigham
authors.affiliation: Radiology (DiagIm), St. James's Hospital, Dublin, Ireland.
authors.forename: Niall
authors.initials: N
authors.lastname: Mceniff
authors.affiliation: Radiology Department, Faculty Hospital Charles University, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Dvorak
authors.affiliation: Diagnostic Imaging and Intervention, Department of Hepatology and Liver Transplants, University of Pisa, Pisa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Crocetti
authors.affiliation: Radiology Department, Oxford University Hospitals NHS Trust, Oxford, UK. Raman.Uberoi@ouh.nhs.uk.
authors.forename: Raman
authors.initials: R
authors.lastname: Uberoi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Disease; Enteral feeding; Gastrointestinal; Gastrojejunostomy/percutaneous endoscopic gastrostomy (PEG); Non-vascular interventions; Organ; Per-oral image-guided gastrostomy (PIG); Radiologically inserted gastrostomy (RIG); Specialty; Stroke; Sub-specialty/technique; Subspecialty/technique