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Nutrition clinique et métabolisme
Volume 14, n° 2
pages 122-125 (juin 2000)
Doi : S0985-0562(00)80069-2
Gastrostomie percutanée par guidage fluoroscopique. Expérience sur 500 patients consécutifs
Fluoroscopically-guided gastrostomy. A 500 patients experience
 

Thierry de Baère
 Service de radiologie interventionnelle, institut Gustave-Rossy, 94805 Villejuif cedex, France 

Résumé

But — Évaluer la faisabilité, la faisabilité, la tolérance et les complications de la gastrostomie percutanée sous guidage fluoroscopique (GPF).

Matériel et méthode — Sur une période de six ans, 500 patients ont été adressés pour GPF, principalement en raison de cancers avancés de la tête et du cou. La gastrostomie percutanée endoscopique n'était pas possible ou était contre-indiquée chez un quart de ces patients. Quatre cent soixante-douze patients ont été suivis pendant 1 à 56 mois (moyenne : 7,2) après la réalisation de la GPF.

Résultats — Cinq cent huit GPF avec gastropexie percutanée ont été réalisées chez 496 patients. Douze patients ont nécessité la réalisation de deux gastrostomies espacées dans le temps. Quatre échecs de la technique sur 512 tentatives correspondent à une faisabilité de 99 %. Des complications majeures sont survenues chez sept patients (1,4 %), toutes dans les 30 premiers jours post-GPF : arrêt cardiaque (n = 1), hémorragie intragstrique (n = 1) traitée par embolisation, péritonites (n = 5) qui ont nécessité cinq laparotomies, dont un décès. Les complications mineures (22,9 % des procédures) étaient essentiellement des dysfonctionnements de la sonde de gastrostomie, presque toujours résolues par un échange de cette sonde.

Conclusion — La GPF présente un taux de faisabilité extrêment élevé. Elle est sûre et permet une prise en charge nutritionnelle adéquate du patient et ceci même lorsque la gastrostomie percutanée endoscopique n'est pas possible.

The full text of this article is available in PDF format.
Summary

Purpose — To evaluate the feasibility, complications, adequate feeding support, and tolerance of fluoroscopically guided gastrostomy (FGG).

Materials and Methods — Over a six-year period, 500 patients were referred for FGG mainly for advanced head and neck malignancies. In a quarter of these patients, percutaneous endoscopic gastrostomy was contraindicated or had failed. Five hundred and eight FGG with T-Fastener gastropexy were performed in 496 patients, with failure of the technique in 4 patients and necessity of a second gastrostomy in 12 patients. Four hundred and seventy six patients were followed up for 1 to 56 months (m = 7.2) after FGG.

Results — FGG was successful in 99% of requests, with only 4 failures in 500 patients. Procedure-related major complications (1.4%) affected 7 patients during the 30 post-procedure days: cardiac failure (n = 1), haemorrhage (n = 1), peritonitis (n = 5), and resulted in one death. There were no major complications after the 30th day. Minor complications represented 5.3% of the procedures before the 30th post-procedure day, and 17.6% thereafter. These long-term minor complications mainly involved tube disturbances and were nearly always resolved once the tube had been exchanged. Such exchanges were easily performed under fluoroscopic guidance except in 2 patients who required a new FGG.

Conclusion — FGG is highly feasible, safe and provides adequate feeding support, even when PEG is impossible. Procedure-related complications are infrequent. Long-term complications, which are mainly tube disturbances, are easily treated

The full text of this article is available in PDF format.

Keywords : cancer, gastrostomie, radiologie interventionnelle

Keywords : cancer, gastrostomy, interventional radiology




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