Abstract
Percutaneous endoscopic and fluoroscopic gastrostomy are preferred over surgical gastrostomy
because they are safer and less expensive. However, these methods sometimes fail due
to inability to find a safe percutaneous path to the stomach. Computed tomography
(CT) has been used to guide safe puncture in such difficult cases, but because it
is slow and tedious, it is seldom used routinely for gastrostomy. Continuous imaging
CT (CTF) combines the safety inherent in the three-dimensional resolution of CT with
the speed and real-time feedback of fluoroscopy. After insufflating the stomach, directed
helical CT is used to find a suitable window for percutaneous entry. Under CT fluoroscopy
(CTF) guidance, a Cope anchor set (Cook, Bloomington, IN) is used to access the stomach
and perform gastropexy. Serial dilatation and tube placement are done with intermittent
CTF. Tube position is confirmed by injection of dilute contrast. In our experience,
CTF has been quick, effective and well tolerated in all patients, extending the range
of gastrostomies that can be performed percutaneously without increasing time or difficulty
of the procedure.
Keywords:
Gastrostomy - CT fluoroscopy - drainage
