Letters

Radiological placement of the gastrostomy tube should be the preferred method

Percutaneous radiologically guided gastrostomy is relatively simple and can be performed in almost any radiology department. A recent analysis of 5752 gastrostomies and a review of the literature involving a further 5680 cases concluded that it is significantly safer and more successful than endoscopic gastrostomy.² Major complications occur significantly less commonly in radiological gastrostomy (5.9%) than in endoscopic gastrostomy (9.4%) or surgical gastrostomy (19.9%). The success rate of radiological gastrostomy is 99.2%, compared with 95.7% for endoscopic placement.

Radiological gastrostomy requires minimal sedation and is preferable to endoscopic gastrostomy, particularly in patients who are prone to aspiration (such as those with dysphagic stroke in Norton and colleagues' study), as the endoscopic method often requires heavy sedation if placement of the tube into the jejunum is considered.³ The tube can be placed in the jejunum easily and rapidly when the radiological method is used, with no additional discomfort to the patient. Unlike with the endoscopic method, the colon can be routinely visualised during radiological gastrostomy so that inadvertent perforation of the colon when it is interposed between the stomach and anterior abdominal wall is avoided. Infection at the site of the tube is less common with the radiological method as the tube is introduced through the surgically scrubbed anterior abdominal wall rather than the contaminated oral cavity.⁴

Since radiological gastrostomy has been found to be the safest and most successful method of placing a gastrostomy tube it should be the method of choice in almost every circumstance.

Consultant radiologist Consultant radiologist Department chairman HCI International Medical Care, Beardmore Street, Clydebank G81 4HX

Brian L Murphy, Paul S Sidhu, Reginald E Greene 

1. Norton B, Homer-Ward M, Donnelly MT, Long RG, Holmes GKT. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphasic stroke. BMJ 1996;312:13-6. (6 January.) [Abstract/Free Full Text]
2. Wollman B, D'Agostino HB, Walus-Wigle JR, Easter DW, Beale A. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology 1995;197:699-704. [Abstract/Free Full Text]
3. Ho CS. Percutaneous gastrostomy and transgastric jejunostomy. In: Kadir S, ed. Current practice of interventional radiology. Philadelphia: BC Decker, 1991:444-9.
4. Nemcek AA, Vogelzang RL. Angiography and interventional radiology. In: Gore RM, Levine MS, Laufer I, eds. Textbook of gastrointestinal radiology. Philadelphia: W B Saunders, 1994:336-40.