Cone-beam computed tomography–assisted percutaneous gastrostomy tube insertion in children with challenging anatomy
5
Issued Date
2023-05-01
Resource Type
ISSN
03010449
eISSN
14321998
Scopus ID
2-s2.0-85147106821
Pubmed ID
36720724
Journal Title
Pediatric Radiology
Volume
53
Issue
5
Start Page
963
End Page
970
Rights Holder(s)
SCOPUS
Bibliographic Citation
Pediatric Radiology Vol.53 No.5 (2023) , 963-970
Suggested Citation
Rohringer T.J., Gladkikh M., Yodying J., Shkumat N.A., Connolly B.L., Parra D.A. Cone-beam computed tomography–assisted percutaneous gastrostomy tube insertion in children with challenging anatomy. Pediatric Radiology Vol.53 No.5 (2023) , 963-970. 970. doi:10.1007/s00247-023-05593-x Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/82061
Title
Cone-beam computed tomography–assisted percutaneous gastrostomy tube insertion in children with challenging anatomy
Other Contributor(s)
Abstract
Background: Percutaneous radiological gastrostomy tube insertion is a common procedure in children. An approach using ultrasound and fluoroscopy may not be feasible in patients with challenging anatomy; therefore, advanced techniques or other imaging modalities may be required. Objective: To describe our experience using cone-beam computed tomography (CT)–assisted percutaneous gastrostomy insertion in pediatric patients with challenging anatomy. Materials and methods: A retrospective review was performed in children who underwent cone-beam CT–assisted percutaneous radiologic gastrostomy between January 2015 and July 2019. Indications, technique, outcomes, complications, and radiation dose (reference-point air kerma, air kerma area product) were assessed through chart and imaging review. Descriptive statistics only were used. Results: Twenty-seven procedures were attempted in 26 patients. Reasons for utilizing cone-beam CT guidance were high-positioned stomach (n = 10), interposing bowel loops and liver (n = 19), omphalocele (n = 1), severe scoliosis (n = 1), and ventriculoperitoneal shunt (n = 1). Technical success was 85% (23/27). Mean procedure time was 96 min (range 50–131 min). No safe access route into the stomach was encountered in four patients; three were referred for surgical gastrostomy and one had a successful re-attempt. Radiation dose data was obtained from 19 procedures (17 successful) with a total dose in successful procedures ranging from 8.1 to 63.6 mGy (average 26.2 mGy, median 24.9 mGy). The number of cone-beam CT acquisitions per procedure ranged from 1 to 4. Major complication frequency was 11% (3/27) (bleeding, peritonitis, and aspiration pneumonia); minor complication frequency was 3.7% (1/27). Conclusion: This study shows that cone-beam CT guidance can be useful for assisting percutaneous radiologic gastrostomy in children with challenging anatomy.