Gastrostomy with CT-fluoroscopic guidance

Percutaneous endoscopic and fluoroscopic gastrostomy are preferred over sur gical gastrostomy because they are safer and less expensive. However, these methods sometimes fail due to inability to find a safe percutaneous path t o the stomach. Computed tomography (CT) has been used to guide safe punctur e in such difficult cases, but because it is slow and tedious, it is seldom used routinely for gastrostomy. Continuous imaging CT (CTF) combines the s afety inherent in the three-dimensional resolution of CT with the speed and real-time feedback of fluoroscopy. After insufflating the stomach, directe d helical CT is used to find a suitable window for percutaneous entry. Unde r CT fluoroscopy (CTF) guidance, a Cope anchor set (Cook, Bloomington, IN) is used to access the stomach and perform gastropexy. Serial dilatation and tube placement are done with intermittent CTF. Tube position is confirmed by injection of dilute contrast. In our experience, CTF has been quick, eff ective and well tolerated in all patients, extending the range of gastrosto mies that can be performed percutaneously without increasing time or diffic ulty of the procedure.