Radiologic Percutaneous Gastrostomy for Enteral Access in Patients Requiring Long-Term Nutritional Support

  • Diego A. Covarrubias
  • Gabriel M. Covarrubias
  • Jessica M. Ho
Reference work entry


The availability of ready access to dietary and nutritional support is a basic necessity for the maintenance of adequate health. Appropriate nutrition becomes even more crucial in the diseased state as the gut is a large, dynamic organ that can have a profound influence on the immune response. Direct enteral access via radiologic percutaneous gastrostomy or gastrojejunostomy tube placement provides a safe and effective means of maintaining nutrition, particularly in chronic disease or critical care situations when long-term, reliable enteric access is required. The following chapter addresses all aspects of RPG, including indications and preparation for placement, procedure technique, potential complications, and care following placement.


Catheter Ischemia Dementia Aspirin Heparin 

List of Abbreviations


Complete blood count


Computed tomography


Enteral nutrition


Gastrojejunostomy tube


Gastrostomy tube


Intensive care unit


International normalized ratio


Low-molecular-weight heparin


Nasogastric tube


Percutaneous endoscopic gastrostomy


Prothrombin time


Partial thromboplastin time


Radiologic percutaneous gastrostomy


Society of Interventional Radiology


Total parenteral nutrition


  1. Alagiakrishnan K, Bhanji RA, Kurian M. Evaluation and management of oropharyngeal dysphagia in different types of dementia: a systematic review. Arch Gerontol Geriatr. 2013;56:1–9.CrossRefPubMedGoogle Scholar
  2. Bazarah SM, Al-Rawas M, Akbar H, Qari Y. Percutaneous gastrostomy and gastrojejunostomy: radiological and endoscopic approach. Ann Saudi Med. 2002;22:38–42.PubMedGoogle Scholar
  3. Beaver ME, Myers JN, Griffenberg L, Kimberly W. Percutaneous fluoroscopic gastrostomy tube placement in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 1998;124:1141–4.CrossRefPubMedGoogle Scholar
  4. Black MT, Hung CA, Loh C. Subcutaneous T-fastener gastropexy: a new technique. Am J Roentgenol. 2013;200:1157–9.CrossRefGoogle Scholar
  5. Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001;74:534–42.PubMedGoogle Scholar
  6. Brooksbank MA, Game PA, Ashby MA. Palliative venting gastrostomy in malignant intestinal obstruction. Palliat Med. 2002;16:520–6.CrossRefPubMedGoogle Scholar
  7. Brown AS, Mueller PR, Ferrucci Jr JT. Controlled percutaneous gastrostomy: nylon T-fastener for fixation of the anterior gastric wall. Radiology. 1986;158:543–5.CrossRefPubMedGoogle Scholar
  8. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108:18–37.CrossRefPubMedGoogle Scholar
  9. Cangelosi MJ, Auerbach HR, Cohen JT. A clinical and economic evaluation of enteral nutrition. Curr Med Res Opin. 2011;27:413–22.CrossRefPubMedGoogle Scholar
  10. Cantwell CP, Gervais DA, Hahn PF, Mueller PR. Feasibility and safety of intracolic fluoroscopically guided percutaneous radiologic gastrostomy. J Vasc Interv Radiol. 2008a;19:129–32.CrossRefPubMedGoogle Scholar
  11. Cantwell CP, Perumpillichira JJ, Maher MM, Hahn PF, Arellano R, Gervais DA, Mueller PR. Antibiotic prophylaxis for percutaneous radiologic gastrostomy and gastrojejunostomy insertion in outpatients with head and neck cancer. J Vasc Interv Radiol. 2008b;19:571–5.CrossRefPubMedGoogle Scholar
  12. Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2009;20:S189–91.CrossRefPubMedGoogle Scholar
  13. Chio A, Galletti R, Finocchiaro C, et al. Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS. J Neurol Neurosurg Psychiatry. 2004;75:645–7.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Collares FB, Faintuch S, Kim SK, Rabkin DJ. Reinsertion of accidentally dislodged catheters through the original track: what is the likelihood of success? J Vasc Interv Radiol. 2010;21:861–4.CrossRefPubMedGoogle Scholar
  15. Cozzi G, Gavazzi C, Civelli E, et al. Percutaneous gastrostomy in oncologic patients: analysis of results and expansion of indications. Abdom Imaging. 2000;25:239–42.CrossRefPubMedGoogle Scholar
  16. Dempsey DT, Mullen JL, Buzby GP. The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr. 1988;47:352–6.PubMedGoogle Scholar
  17. Dewald CL, Hiette PO, Sewall LE, et al. Percutaneous gastrostomy and gastrojejunostomy with gastropexy: experience in 701 procedures. Radiology. 1999;211:651–6.CrossRefPubMedGoogle Scholar
  18. DeWys WD. Nutritional care of the cancer patient. JAMA. 1980;244:374–6.CrossRefPubMedGoogle Scholar
  19. Dwyer KM, Watts DD, Thurber JS, Benoit RS, Fakhry SM. Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients. J Trauma. 2002;52:26–32.PubMedGoogle Scholar
  20. Eisen GM, Baron TH, Dominitz JA, et al. Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastrointest Endosc. 2002;55:775–9.CrossRefPubMedGoogle Scholar
  21. Fleischer I, Bryant D. Techniques for preventing and managing tube-related complications. J Wound Ostomy Continence Nurs. 2010;37:686–90.CrossRefPubMedGoogle Scholar
  22. Foster A, Given M, Thornton E, Geoghegan T, Keeling F, McGrath F, Lee MJ. Removal of T-fasteners 2 days after gastrostomy is feasible. Cardiovasc Intervent Radiol. 2009;32:317–9.CrossRefPubMedGoogle Scholar
  23. Given MF, Hanson JJ, Lee MJ. Interventional radiology techniques for provision of enteral feeding. Cardiovasc Intervent Radiol. 2005;28:692–703.CrossRefPubMedGoogle Scholar
  24. Haydock DA, Hill GL. Improved wound healing response in surgical patients receiving intravenous nutrition. Br J Surg. 1987;74:320–3.CrossRefPubMedGoogle Scholar
  25. Hicks ME, Surratt RS, Picus D, Marx MV, Lang EV. Fluoroscopically guided percutaneous gastrostomy and gastroenterostomy: analysis of 158 consecutive cases. Am J Roentgenol. 1990;154:725–8.CrossRefGoogle Scholar
  26. Itkin M, Delegge MH, Fang JC, et al. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). J Vasc Interv Radiol. 2011;22:1089–106.CrossRefPubMedGoogle Scholar
  27. Keymling M. Technical aspects of enteral nutrition. Gut. 1994;35:S77–80.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Kim CH, Nelson DK. Venting percutaneous gastrostomy in the treatment of refractory idiopathic gastroparesis. Gastrointest Endosc. 1998;47:67–70.CrossRefPubMedGoogle Scholar
  29. Kiyama T, Efron DT, Tantry J, Barbul A. Trauma and wound healing: role of the route of nutritional support. Int J Surg. 2001;2:483–9.Google Scholar
  30. Koc D, Gercek A, Gencosmanoglu R, Tozun N. Percutaneous endoscopic gastrostomy in the neurosurgical intensive care unit: complications and outcome. J Parenter Enteral Nutr. 2007;31:517–20.CrossRefGoogle Scholar
  31. Kostadima E, Kaditis AG, Alexopoulos EI, Zakynthinos E, Sfyras D. Early gastrostomy reduces the rate of ventilator- associated pneumonia in stroke or head injury patients. Eur Respir J. 2005;26:106–11.CrossRefPubMedGoogle Scholar
  32. Kreis BE, Middelkoop P, Vloemans AFPM, Kreis RW. Use of PEG tube in burn centre. Burns. 2002;28:191–7.CrossRefPubMedGoogle Scholar
  33. Kuo B, Castell DO. The effect of nasogastric intubation on gastroesophageal reflux: a comparison of different tube sizes. Am J Gastroenterol. 1995;90:1804–7.PubMedGoogle Scholar
  34. Laasch HU, Martin DF. Radiologic gastrostomy. Endoscopy. 2007;39:247–55.CrossRefPubMedGoogle Scholar
  35. Lee MJ, Saini S, Brink JA, et al. Malignant small bowel obstruction and ascites: not a contraindication to percutaneous gastrostomy. Clin Radiol. 1991;44:332–4.CrossRefPubMedGoogle Scholar
  36. Lu DS, Mueller PR, Lee MJ, et al. Gastrostomy conversion to transgastric jejunostomy: technical problems, causes of failure, and proposed solutions in 63 patients. Radiology. 1993;187:679–83.CrossRefPubMedGoogle Scholar
  37. Malloy PC, Grassi CJ, Kundu S, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2009;20:S240–9.CrossRefPubMedGoogle Scholar
  38. McClave SA. Critical care nutrition: getting involved as a gastrointestinal endoscopist. J Clin Gastroenterol. 2006;40:870–90.CrossRefPubMedGoogle Scholar
  39. Mosier MJ, Pham TN, Klein MB, et al. Early nutrition in burns: compliance with guidelines and associated outcomes in a multicenter study. J Burn Care Res. 2011;32:104–9.CrossRefPubMedGoogle Scholar
  40. Ozmen MN, Akham O. Percutaneous radiologic gastrostomy. Eur J Radiol. 2002;43:186–95.CrossRefPubMedGoogle Scholar
  41. Park JH, Kang SW. Percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis on noninvasive ventilation. Arch Phys Med Rehabil. 2009;90:1026–9.CrossRefPubMedGoogle Scholar
  42. Patton ML, Haith Jr LR, Germain TJ, Goldman WT, Raymond OT. Use of percutaneous endoscopic gastrostomy tubes in burn patients. Surg Endosc. 1994;8:1067–72.CrossRefPubMedGoogle Scholar
  43. Perona F, Castellazzi G, De Iuliis A, Rizzo L. Percutaneous radiologic gastrostomy: a 12-year series. Gut Liver. 2010;4:S44–9.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Rossi UG, Petrocelli F, Seitun S, Patrone L, Ferro C. Percutaneous radiological gastrostomy: single-puncture double-anchor technique. Radiol Med. 2013;118:356–65. Epub 2012 Oct 22.CrossRefPubMedGoogle Scholar
  45. Rouby JJ, Laurent P, Gosnach M, et al. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med. 1994;150:776–83.CrossRefPubMedGoogle Scholar
  46. Seron-Arbeloa C, Zamora-Elson M, Labarta-Monzon L, Mallor-Boneta T. Enteral nutrition in critical care. J Clin Med Res. 2013;5:1–11.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Shastri YM, Hoepffner N, Tessmer A, Ackermann H, Schroeder O, Stein J. New introducer PEG gastropexy does not require prophylactic antibiotics: multicenter prospective randomized double-blind placebo-controlled study. Gastrointest Endosc. 2008;67:620–8.CrossRefPubMedGoogle Scholar
  48. Shaw C, Bassett RL, Fox PS, et al. Palliative venting gastrostomy in patients with malignant bowel obstruction and ascites. Ann Surg Oncol. 2013;20:497–505.CrossRefPubMedGoogle Scholar
  49. Shin JH, Park A. Updates on percutaneous radiologic gastrostomy/gastrojejunostomy and jejunostomy. Gut Liver. 2010;4:25–31.CrossRefGoogle Scholar
  50. Shin JH, Song HY, Kim TH, et al. Percutaneous radiologic gastrostomy: a modified Chiba-needle puncture technique with single gastropexy. Abdom Imaging. 2010;35:189–94.CrossRefPubMedGoogle Scholar
  51. Sinclair JJ, Scolapio JS, Stak ME, Hinder RA. Metastasis of head and neck carcinoma to the site of percutaneous endoscopic gastrostomy: case report and literature review. J Parenter Enteral Nutr. 2001;25:282–5.CrossRefGoogle Scholar
  52. Teno JM, Gozalo PL, Mitchell SL, Kuo S, Rhodes RL, Bnum JP, Mor V. Does feeding tube insertion and its timing improve survival? J Am Geriatr Soc. 2012;60:1918–21.CrossRefPubMedPubMedCentralGoogle Scholar
  53. Thornton FJ, Fotheringham T, Alexander M, Hardiman O, McGrath FP, Lee MJ. Amyotrophic lateral sclerosis: enteral nutrition provision – endoscopic or radiologic gastronomy? Radiology. 2002;224:713–7.CrossRefPubMedGoogle Scholar
  54. Wollman B, D’Agostino HB, Walus-Wigle JR, Easter DW, Beale A. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology. 1995;197:699–704.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Diego A. Covarrubias
    • 1
  • Gabriel M. Covarrubias
    • 2
  • Jessica M. Ho
    • 3
  1. 1.Interventional Radiology, Diagnostic Imaging ServicesKaiser Permanente West Los Angeles Medical CenterLos AngelesUSA
  2. 2.Department of RadiologyColumbia University Medical Center / New York-Presbyterian HospitalNew YorkUSA
  3. 3.Department of RadiologyUniversity of Southern California Keck School of MedicineLos AngelesUSA

Personalised recommendations