Percutaneous Radiologic Gastrostomy: Navigating Angles with Balloon Assistance
Percutaneous radiologic gastrostomy is a procedure where air is injected into the stomach, then the stomach wall is pressed against the abdominal wall. Under fluoroscopy guidance, a needle is used from outside the skin to puncture the stomach, and then a tube is inserted
Today, I will introduce a PRG (Percutaneous Radiologic Gastrostomy) case that I performed.
(49 male patient)
After injecting air through an L tube, the expanded stomach is viewed under fluoroscopy and then punctured with a needle.
If the stomach is accurately punctured with the needle, air will leak out through it.
To verify this more clearly, contrast media is injected through the needle.
This allows for the visualization of the inner wall of the stomach and the accumulation of contrast media in the fundus.
After puncturing the distal body or antrum of the stomach with a needle, an anchor is inserted.
This anchor has a thread connected to the outside of the skin.
By pulling this thread taut, the stomach wall is pressed against the abdominal wall.
While keeping the stomach wall adhered to the abdominal wall, the site for the gastrostomy tube is punctured and then the tube is inserted.
This approach minimizes complications such as infections and ensures effective puncturing.
After completing the third puncture, a dilator is used to enlarge the opening. The hole size is increased using dilators ranging from 8French to 24French, and then the tube is inserted.
However, in our case, the angle of the third puncture was too flat, making it difficult for the tube to be inserted. While the dilator is rigid, the tube is made of a softer material, which made it challenging to pass through the flat angle.
To overcome this flat angle, we used a balloon. By inserting the balloon in front of the gastrostomy tube and expanding the tract, we utilized the firmness of the inflated balloon to push it through to the inside of the stomach.
