Infra-colic gastrostomy: Technique and anatomical considerations
Background : : Infra-colic radiologically inserted gastrostomy is not well documented, and the presence of an insertion window solely below the transverse colon is generally regarded as a contraindication to gastrostomy insertion. A perceived increased risk is due to the presence of vessels and lymp...
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| Format: | Article |
| Language: | English |
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Society of Gastrointestinal Intervention
2021-01-01
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| Series: | International Journal of Gastrointestinal Intervention |
| Subjects: | |
| Online Access: | https://doi.org/10.18528/ijgii190013 |
| _version_ | 1818920115225231360 |
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| author | Jen-Jou Wong Srujana Ganti Damian Mullan Derek Edwards Hans-Ulrich Laasch |
| author_facet | Jen-Jou Wong Srujana Ganti Damian Mullan Derek Edwards Hans-Ulrich Laasch |
| author_sort | Jen-Jou Wong |
| collection | DOAJ |
| description | Background : : Infra-colic radiologically inserted gastrostomy is not well documented, and the presence of an insertion window solely below the transverse colon is generally regarded as a contraindication to gastrostomy insertion. A perceived increased risk is due to the presence of vessels and lymphatics within the omental and peritoneal structures, such as the epiploic arteries, the arterial arcade of Barkow, and middle colic artery branches from the superior mesenteric artery. Colonic obstruction is also an additional theorised risk. We provide evidence that infra-colic insertion of a feeding tube through the greater omentum can be performed safely. Methods : : A total of 1,156 gastrostomies were inserted over an 8-year period. A retrospective review of the 5 cases was conducted. Electronic patient records were reviewed including clinical consultations, procedure reports and images. Results : : In all cases, barium was administered orally/per nasogastric tube the day before to delineate the colon. All patients underwent sedo-analgesia with insufflation of the stomach achieved by a temporising nasogastric/orogastric tube. Infra-colic gastropexy with three SafeTpexy T-fasteners was undertaken. Standard 12 Fr balloon retained tubes were inserted through the greater omentum with no post-procedural complications or tube malfunctions in four cases. A 16 Fr disc retained tube was inserted in a fifth case. Conclusion : : Despite the perceived difficulties, we suggest that infra-colic gastrostomies can be performed with confidence, and with little deviation from standard insertion techniques. They can be inserted without an apparent increase in complications, although operators need to be aware of the anatomical differences and additional structures traversed when performing infra-colic gastrostomies. |
| first_indexed | 2024-12-20T01:16:37Z |
| format | Article |
| id | doaj.art-19844c4c51534fc09f338384bfd62490 |
| institution | Directory Open Access Journal |
| issn | 2636-0004 |
| language | English |
| last_indexed | 2024-12-20T01:16:37Z |
| publishDate | 2021-01-01 |
| publisher | Society of Gastrointestinal Intervention |
| record_format | Article |
| series | International Journal of Gastrointestinal Intervention |
| spelling | doaj.art-19844c4c51534fc09f338384bfd624902022-12-21T19:58:34ZengSociety of Gastrointestinal InterventionInternational Journal of Gastrointestinal Intervention2636-00042021-01-01101121610.18528/ijgii19001310.ijgii190013Infra-colic gastrostomy: Technique and anatomical considerationsJen-Jou Wong0Srujana Ganti1Damian Mullan2Derek Edwards3Hans-Ulrich Laasch4Department of Radiology, The Christie NHS Foundation Trust, Manchester, UKDepartment of Radiology, The Christie NHS Foundation Trust, Manchester, UKDepartment of Radiology, The Christie NHS Foundation Trust, Manchester, UKDepartment of Radiology, The Christie NHS Foundation Trust, Manchester, UKDepartment of Radiology, The Christie NHS Foundation Trust, Manchester, UKBackground : : Infra-colic radiologically inserted gastrostomy is not well documented, and the presence of an insertion window solely below the transverse colon is generally regarded as a contraindication to gastrostomy insertion. A perceived increased risk is due to the presence of vessels and lymphatics within the omental and peritoneal structures, such as the epiploic arteries, the arterial arcade of Barkow, and middle colic artery branches from the superior mesenteric artery. Colonic obstruction is also an additional theorised risk. We provide evidence that infra-colic insertion of a feeding tube through the greater omentum can be performed safely. Methods : : A total of 1,156 gastrostomies were inserted over an 8-year period. A retrospective review of the 5 cases was conducted. Electronic patient records were reviewed including clinical consultations, procedure reports and images. Results : : In all cases, barium was administered orally/per nasogastric tube the day before to delineate the colon. All patients underwent sedo-analgesia with insufflation of the stomach achieved by a temporising nasogastric/orogastric tube. Infra-colic gastropexy with three SafeTpexy T-fasteners was undertaken. Standard 12 Fr balloon retained tubes were inserted through the greater omentum with no post-procedural complications or tube malfunctions in four cases. A 16 Fr disc retained tube was inserted in a fifth case. Conclusion : : Despite the perceived difficulties, we suggest that infra-colic gastrostomies can be performed with confidence, and with little deviation from standard insertion techniques. They can be inserted without an apparent increase in complications, although operators need to be aware of the anatomical differences and additional structures traversed when performing infra-colic gastrostomies.https://doi.org/10.18528/ijgii190013fluoroscopy; gastrostomy; omentum; radiologyinterventional; stomach |
| spellingShingle | Jen-Jou Wong Srujana Ganti Damian Mullan Derek Edwards Hans-Ulrich Laasch Infra-colic gastrostomy: Technique and anatomical considerations International Journal of Gastrointestinal Intervention fluoroscopy; gastrostomy; omentum; radiology interventional; stomach |
| title | Infra-colic gastrostomy: Technique and anatomical considerations |
| title_full | Infra-colic gastrostomy: Technique and anatomical considerations |
| title_fullStr | Infra-colic gastrostomy: Technique and anatomical considerations |
| title_full_unstemmed | Infra-colic gastrostomy: Technique and anatomical considerations |
| title_short | Infra-colic gastrostomy: Technique and anatomical considerations |
| title_sort | infra colic gastrostomy technique and anatomical considerations |
| topic | fluoroscopy; gastrostomy; omentum; radiology interventional; stomach |
| url | https://doi.org/10.18528/ijgii190013 |
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