A Literature Review of Infracolic Gastrostomy Techniques and Outcomes

Percutaneous radiologic gastrostomies are traditionally done using a supracolic approach due to the perceived increased risk of postprocedural hemorrhage associated with an infracolic approach. Many interventional radiologists will decline attempts at placing a gastrostomy tube in situations of colonic interposition, requiring patients to undergo surgery. The goal of this review was to understand the safety and technique of infracolic gastrostomies to assess the validity of these concerns. There were 12 cases of infracolic gastrostomies identified across two retrospective studies and one case report. All gastrostomy tubes were inserted successfully with no abandoned procedures with the only minor variation in technique being that the colon was displaced superiorly as opposed to inferiorly like in the traditional supracolic approach. Across the two retrospective studies, the percentage of infracolic gastrostomies done during the study period was 1.18% (6 out of 508) and 0.43% (5 out of 1,156). There were no immediate postprocedural complications reported in the study done with six patients who underwent infracolic gastrostomies, but there were two deaths during the followup period, both of which were attributed to disease progression. In the study with five patients who had undergone infracolic gastrostomies, there was one minor complication of site soreness along with one case of death due to sepsis secondary to aspiration of the barium contrast used to delineate the colon prior to the procedure. This is a rare complication that can occur when a barium swallow is done, especially in this case where the patient was older and had comorbidities that increased the aspiration risk. Evidently, infracolic gastrostomies have been inserted in the past with minimal complications. However, due to the limited sample size, the safety of this technique cannot be established without future prospective studies.