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Radiologic Retrograde Gastrostomy Tube Insertions

Without the Use of Barium: Implications for


Radiation Dose in Children
RFS Journal Primer

Quick Summary
BOTTOM LINE

Percutaneous gastrostomy tube placement without opacification of the colon with barium reduced
radiation dose and fluoroscopy time. This method also makes the procedure more tolerable for the
patient by avoiding the need for oral barium and also less invasive by eliminating the need for
administration of rectal barium.

MAJOR POINTS

Sample consisted of 112 total patients (52 with barium, 60 without barium) met the inclusion
criteria within the designated

Analysis included fluoroscopy time, total radiation dose, dose-area product (DAP), time and weight
adjusted DAP

Patient who underwent the procedure without barium experienced a 50% or greater reduction in all
factors analyzed

Complications rates, including colonic perforation, were higher in the non-barium group however
the authors state that when compared to other literature this rate was comparable and therefore
they felt it was not actually increased in their study

CRITICISM

Retrospective study

Small sample size, creating the appearance of higher complication rates in non-barium group

The need for modern IR suite

Study design
Single Center Retrospective Review

308 patients underwent tube insertion

2011-2013

112 met inclusion criteria

INCLUSION CRITERIA

Patient weight between 5 and 20 kg

Procedure performed in either one of their two modern IR suites

EXCLUSION CRITERIA

Procedure performed in older IR suite

GJ tube patients

Patients undergoing additional fluoroscopic procedure under same sedation

Children < 5 kg or >20 kg

Patients who underwent enterostomy maintenance procedures

Purpose

To evaluate whether performing fluoroscopic guided gastrostomy tube placement without


barium opacification of the colon affected the patient radiation dose.

Complication rates between two groups were also analyzed.

Intervention

Radiologic Gastrostomy Tube Insertion Without Barium


Liver, spleen, stomach and adjacent bowel loops identified with ultrasound

Stomach with distended via nasogastric tube; this is monitored using US and
fluoroscopy

Stomach is punctured with a needle under US and fluoroscopy guidance

Gastrostomy tube inserted over a wire

Intervention

Outcome

Patient who underwent the procedure without barium experienced a 50% or greater reduction
in all factors analyzed

Credits

Insert Institution Logo

SUMMARY BY:

Steven Morales, MD
Department of Radiology
University of Iowa
Kelly B, Mullen E, Connolly B. Radiologic Retrograde Gastrostomy Tube Insertions Without the Use of Barium: Implications for
Radiation Dose in Children. American Journal of Radiology; 205: 1135-1138.

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