REGULAR CONTENT
Final ID
641
Type
Educational Exhibit-Poster Only
Authors
M Gaballah1, A Cahill1, S Shellikeri1, G Krishnamurthy1, S Vatsky1, M Keller1, A Srinivasan1
Institutions
1Children's Hospital of Philadelphia, Philadelphia, PA
Purpose
To describe our experience utilizing adjunctive techniques to increase the safety and success of primary antegrade percutaneous gastrostomy (G) and gastrojejunostomy (GJ) tube placements in a subspecialty of children.
Materials & Methods
A retrospective review was performed to identify primary antegrade percutaneous G- and GJ-tubes placed using adjunctive techniques over a 10-year period. 16F Corpak Gastrostomy and 6F Cor-flo jejunostomy tubes (CORPAK MedSystems, Inc., Buffalo Grove, IL) were placed.
Results
Seven primary placements (4 GJ- and 3 G-tubes) using adjunctive techniques in seven children were identified, median age 2.9 years (4 months – 12.8 yrs), mean weight 14.4 kg (4.5 – 31 kg).Adjunctive techniques included the use of low dose C-arm CT guidance for more adequate determination of a percutaneous window in 2 cases, for confirmation of intra-gastric needle location in one case, and for confirmation of final gastrostomy tube position in one case. Additionally needle decompression of anterior jejunal loops, live percutaneous needle guidance using iGuide software, and inflation of a Fogarty balloon within the proximal duodenum to reduce gastric decompression following insufflation were each used in one case. Indications for adjunctive techniques included severe congenital scoliosis, capacious anterior colon, post-conjoint twin separation, history of jejunal atresia, and rapid gastric decompression following insufflation which had precluded recent prior tube placement. No intra-procedural complications occurred. No major complications occurred during a follow-up consisting of a total of 5505 days of tube life.Mean procedure time was 80 minutes (35 – 120 min). Mean dose area product for procedures was 401.2 microGy-m2 (17.6 – 1040 microGy-m2).
Conclusions
The use of adjunctive techniques in primary antegrade percutaneous G- and GJ- tube placements may be considered in particularly challenging anatomic situations to increase technical success, for example in children with scoliosis, aberrant intra-abdominal anatomy, or dilated jejunal loops precluding safe access into the stomach.
Final ID
641
Type
Educational Exhibit-Poster Only
Authors
M Gaballah1, A Cahill1, S Shellikeri1, G Krishnamurthy1, S Vatsky1, M Keller1, A Srinivasan1
Institutions
1Children's Hospital of Philadelphia, Philadelphia, PA
Purpose
To describe our experience utilizing adjunctive techniques to increase the safety and success of primary antegrade percutaneous gastrostomy (G) and gastrojejunostomy (GJ) tube placements in a subspecialty of children.
Materials & Methods
A retrospective review was performed to identify primary antegrade percutaneous G- and GJ-tubes placed using adjunctive techniques over a 10-year period. 16F Corpak Gastrostomy and 6F Cor-flo jejunostomy tubes (CORPAK MedSystems, Inc., Buffalo Grove, IL) were placed.
Results
Seven primary placements (4 GJ- and 3 G-tubes) using adjunctive techniques in seven children were identified, median age 2.9 years (4 months – 12.8 yrs), mean weight 14.4 kg (4.5 – 31 kg).Adjunctive techniques included the use of low dose C-arm CT guidance for more adequate determination of a percutaneous window in 2 cases, for confirmation of intra-gastric needle location in one case, and for confirmation of final gastrostomy tube position in one case. Additionally needle decompression of anterior jejunal loops, live percutaneous needle guidance using iGuide software, and inflation of a Fogarty balloon within the proximal duodenum to reduce gastric decompression following insufflation were each used in one case. Indications for adjunctive techniques included severe congenital scoliosis, capacious anterior colon, post-conjoint twin separation, history of jejunal atresia, and rapid gastric decompression following insufflation which had precluded recent prior tube placement. No intra-procedural complications occurred. No major complications occurred during a follow-up consisting of a total of 5505 days of tube life.Mean procedure time was 80 minutes (35 – 120 min). Mean dose area product for procedures was 401.2 microGy-m2 (17.6 – 1040 microGy-m2).
Conclusions
The use of adjunctive techniques in primary antegrade percutaneous G- and GJ- tube placements may be considered in particularly challenging anatomic situations to increase technical success, for example in children with scoliosis, aberrant intra-abdominal anatomy, or dilated jejunal loops precluding safe access into the stomach.