Percutaneous gastrostomy with fluoroscopic guidance: Single-center experience in 500 consecutive cancer patients

PURPOSE: To evaluate the feasibility, complications, adequacy of feeding su pport, and tolerability of fluoroscopically guided gastrostomy in cancer pa tients. MATERIALS AND METHODS: Five hundred cancer patients were referred for fluor oscopically guided gastrostomy, among whom percutaneous endoscopic gastrost omy was contraindicated or had been unsuccessful in approximately one-fourt h. Five hundred eight fluoroscopically guided gastrostomies with T-fastener gastropexy were performed in 496 patients. The procedure was unsuccessful in four patients, and 12 patients needed a second gastrostomy. RESULTS: Fluoroscopically guided gastrostomy was feasible in 99% of patient s. During the first 30 postprocedure days, there were seven major complicat ions (1.4%): cardiac failure (n = 1), hemorrhage (n = 1), and peritonitis ( n = 5); one patient died of peritonitis. No major complications occurred af ter the 30th postprocedure day. There were 27 minor complications (5.4%) du ring the first 30 postprocedure days and 88 (17.6%) thereafter. Long-term m inor complications mainly involved tube disturbances and nearly always reso lved once the tube was,,exchanged. Such exchanges were easily performed und er fluoroscopic guidance except in two patients, who required repeat fluoro scopically guided gastrostomy. CONCLUSION: Fluoroscopically guided gastrostomy is highly feasible and safe and provides adequate feeding support, even when percutaneous endoscopic g astrostomy is impossible. Long-term complications, which are mainly tube di sturbances, are easily treated.