Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
Department of Radiology, Charité-Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Tomography. 2024 Nov 6;10(11):1754-1766. doi: 10.3390/tomography10110129.
BACKGROUND/OBJECTIVES: This study was conducted to compare two modes of computed tomography fluoroscopy (CTF) and two gastropexy techniques used in CT-guided percutaneous radiologic gastrostomy (CT-PRG) aiming to identify the optimal techniques for image guidance and gastropexy and, thus, to overcome the current lack of consensus on the preferred modalities.
We retrospectively identified 186 successful CT-PRG procedures conducted evenly across two university hospitals from January 2019 to December 2023. Patients were divided into two groups (intermittent multislice CT biopsy mode-guided technique (MS-CT BM) and retention anchor suture (T-fastener) versus real-time (RT-)CTF and gastropexy device) for descriptive analysis of demographics, indication for PRG, radiation exposure (DLP), procedural time, number of CT scans, gastropexy time, and complications. Differences were assessed for statistical significance using Fisher's exact test and the Mann-Whitney U-test.
Our final study population comprised 100 patients (50 from each center; 62.52 ± 12.36 years, 73 men). There was a significant difference in radiation exposure between MS-CT BM (group 1) and RT-CTF (group 2), with an average dose-length product (DLP) of 56.28 mGycm×m ± 67.89 and 30.91 ± 27.53 mGycm×cm, respectively ( < 0.001). PRG with RT-CTF guidance was significantly faster than PRG with MS-CT BM, with an average difference of 10.28 min ( < 0.001). No significant difference in duration was found between the two gastropexy methods compared (retention anchor suture, 11.50 ± 5.239 s vs. gastropexy device, 11.17 ± 6.015 s; = 0.463). Complication rates did not differ significantly either ( = 0.458).
Our findings indicate comparable efficacy and safety of the two gastropexy methods and underscore that the choice of CTF mode for image guidance has only a small role in reducing radiation exposure in patients undergoing CT-PRG. Instead, it is essential to avoid control scans.
背景/目的：本研究旨在比较两种计算机断层扫描透视（CTF）模式和两种胃固定技术在 CT 引导经皮放射胃造瘘术（CT-PRG）中的应用，以确定用于图像引导和胃固定的最佳技术，从而克服目前在首选方式上缺乏共识的问题。
我们回顾性地确定了 2019 年 1 月至 2023 年 12 月期间在两家大学医院进行的 186 例成功的 CT-PRG 手术。将患者分为两组（间歇性多层 CT 活检模式引导技术（MS-CT BM）和保留锚缝线（T 型夹）与实时（RT）-CTF 和胃固定装置），用于描述性分析人口统计学、PRG 适应证、辐射暴露（DLP）、手术时间、CT 扫描次数、胃固定时间和并发症。使用 Fisher 精确检验和 Mann-Whitney U 检验评估差异的统计学意义。
我们的最终研究人群包括 100 例患者（每个中心 50 例；62.52 ± 12.36 岁，73 名男性）。MS-CT BM（第 1 组）和 RT-CTF（第 2 组）之间的辐射暴露存在显著差异，平均剂量长度乘积（DLP）分别为 56.28 mGycm×m ± 67.89 和 30.91 ± 27.53 mGycm×cm（<0.001）。与 MS-CT BM 引导的 PRG 相比，RT-CTF 引导的 PRG 明显更快，平均相差 10.28 分钟（<0.001）。两种胃固定方法的持续时间无显著差异（保留锚缝线，11.50 ± 5.239 s 与胃固定装置，11.17 ± 6.015 s； = 0.463）。并发症发生率也无显著差异（ = 0.458）。
我们的研究结果表明，两种胃固定方法具有相似的疗效和安全性，并且强调在进行 CT-PRG 时，CTF 模式的选择在降低患者的辐射暴露方面仅起到很小的作用。相反，避免控制扫描至关重要。
