Percutaneous feeding gastrostomy in patients with a partial gastrectomy: transhepatic approach with CT guidance.

Abstract

Percutaneous gastrostomy in patients with a partial gastrectomy is rarely performed because the gastric remnants are generally small, positioned high subcostally, and overlaid by the transverse colon and the left lobe of the liver. We performed percutaneous transhepatic feeding gastrostomy in four patients with a partial gastrectomy whose conditions precluded oral feeding. The gastric remnant was punctured with a 22-gauge percutaneous transhepatic cholangiography needle through the left lobe of the liver with computed tomography guidance and following tract dilation over the guidewire 8 or 9F. Cope loop catheters were fluoroscopically placed. No obvious complications were encountered during the procedures. The catheter feedings were continued for 2 to 7 months without any serious problems. We conclude this technique can be performed easily and may be safe because of the presence of the adhesion between the remnant and the liver, which prevents a massive hemorrhage or the displacement of the catheters.