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Establishing radiological percutaneous gastrostomy with balloon-retained tubes as an alternative to endoscopic and surgical gastrostomy in patients with tumours of the head and neck or oesophagus

Departments of ¹ Diagnostic Radiology, ² Radiation Oncology and ³ Otolaryngology, Head and Neck Surgery, University of Bern, Inselspital, Freiburgstrasse, CH 3010 Bern, Switzerland

View larger version (116K): [in a new window]   Figure 1. Technique of radiological percutaneous gastrostomy. (a) Spot radiograph. The T-fastener (arrow) is mounted inside an 18 G needle. (b) Spot shot radiograph. After the gastric wall has been entered, and air could be aspirated, the anchor (arrow) is thrust inside the stomach with a wire. (c) Clinical view after insertion of the peel-away sheath together with a fitting dilator. (d) Spot radiograph after insertion of the peel-away sheath, with the gastrostomy tube inside the sheath before inflation of the balloon. Note the four T-fasteners, arranged in a diamond configuration, which hold the stomach close to the abdominal wall. The arrow marks the two loose ends of the peel-away sheath. (e) Lateral spot radiograph of another patient showing the outer retention plate and blocked retention balloon. (f) Clinical view after completion of the procedure. Note the four sutures of the T-fasteners. The outer retention plate has been retracted to skin level. Note that the feeding port and the Luer-lock balloon port (arrow) are clearly labelled to avoid incorrect injection into the retention balloon.