E-ISSN 1305-3612
Interventional Radiology - Original Article
Percutaneous radiologically guided gastrostomy tube placement: comparison of antegrade transoral and retrograde transabdominal approaches
1 Division of Vascular and Interventional Radiology Department of Radiology, NYU Langone Medical Center, New York, NY, USA  
2 Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA  
Diagn Interv Radiol 2017; 23: 55-60
DOI: 10.5152/dir.2016.15626

PURPOSEWe aimed to compare the antegrade transoral and the retrograde transabdominal approaches for fluoroscopy-guided percutaneous gastrostomy tube (G-tube) placement.


METHODSFollowing institutional review board approval, all G-tubes at two academic hospitals (January 2014 to May 2015) were reviewed retrospectively. Retrograde approach was used at Hospital 1 and both antegrade and retrograde approaches were used at Hospital 2. Chart review determined type of anesthesia used during placement, dose of radiation used, fluoroscopy time, procedure time, medical history, and complications.


RESULTSA total of 149 patients (64 women, 85 men; mean age, 64.4±1.3 years) underwent G-tube placement, including 93 (62%) placed via the retrograde transabdominal approach and 56 (38%) placed via the antegrade transoral approach. Retrograde placement entailed fewer anesthesiology consultations (P < 0.001), less overall procedure time (P = 0.023), and less fluoroscopy time (P < 0.001). A comparison of approaches for placement within the same hospital demonstrated that the retrograde approach led to significantly reduced radiation dose (P = 0.022). There were no differences in minor complication rates (13%–19%; P = 0.430), or major complication rates 6%–7%; P = 0.871) between the two techniques.


CONCLUSION:G-tube placement using the retrograde transabdominal approach is associated with less fluoroscopy time, procedure time, radiation exposure, and need for anesthesiology consultation with similar safety profile compared with the antegrade transoral approach. Additionally, it is hypothesized that decreased procedure time and anesthesiology consultation using the transoral approach are likely associated with reduced cost.

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