Gastrointestinal Radiology > Procedures > CT-Guided Perc. Gastrostomy > CT-Guided Perc. Gastrostomy (8)

CT-Guided Percutaneous Gastrostomy: A Tutorial

Step 10: While maintaining traction on the gastrointestinal anchor, suture the thread to the skin with mild tension. This secures the stomach to the abdominal wall for the remainder of the procedure. Alternatively, the suture thread can be attached to a pair of forceps against the skin surface. If this method is chosen, the suture thread is looped and fixed to the gastrostomy tube at the end of the procedure.

Securing T-bar with skin suture by needle (arrow)

Step 11: The guidewire is now used to maintain access to the gastric lumen during passage of successive fascial dilators and introduction of the gastrostomy catheter. Some operators exchange the original guidewire (70 cm) for a longer (100 cm) guidewire to maintain purchase in the gastric lumen during dilator and catheter exchange. This exchange is performed through the relatively short first dilator (usually 6-French).

Step 12: Dilate the tract using successive fascial dilators to the size of the gastrostomy tube. Maintain gastric distension using the insufflation bulb during exchanges.

Dilating the gastrostomy tract