Percutaneous transhepatic gastrostomy with CT guidance in patients with partial gastrectomy

Percutaneous transhepatic gastrostomy was performed in two patients, one with partial gastrectomy and Billroth I anastomosis and one with esophageal reconstruction with subtotal stomach, in whom oral feeding was precluded. In both patients, percutaneous gastrostomy with fluoroscopic guidance was impossible since the gastric remnants were small, had a high subcostal position, and were overlain by the transverse colon, lung and left lobe of the liver. The only route available to avoid the overlying bowel and lung was the transhepatic approach. The gastric remnants were punctured with a 22-gauge PTC needle through the left lobe of the liver with CT guidance, and an 8 Fr. Cope-type catheter was fluoroscopically placed in the gastric remnant or the duodenum after tract dilatation over the guide wire. No complications occurred during or after the procedures, and the condition of both patients was greatly improved. Although gastrostomy in patients with partial gastrectomy is thought to be very difficult, percutaneous transhepatic gastrostomy with CT guidance is easy and may be safe since adhesion between the liver and gastric remnant can prevent massive hemorrhage or displacement of the catheters.