Gastrostomie percutanee par guidage fluoroscopique. Experience sur 500 patients consecutifs

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. (C) 2000 Editions scientifiques et medicales Elsevier SAS.