Radiofrequency ablation for neuroendocrine liver metastases: a systematic review.

To determine the efficacy of radiofrequency (RF) ablation in neuroendocrine tumor (NET) liver metastases. A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight studies were included (N = 301). Twenty-six percent of RF ablation procedures were percutaneous (n = 156), with the remainder conducted at surgery. Forty-eight percent of patients had a concomitant liver resection. Fifty-four percent of patients presented with symptoms, with 92% reporting symptom improvement following RF ablation (alone or in combination with surgery). The median duration of symptom improvement was 14-27 months. However, recurrence was common (63%-87%). RF ablation can provide symptomatic relief in NET liver metastases alone or in combination with surgery.

Hepatocellular carcinoma: illustrated guide to systematic radiologic diagnosis and staging according to guidelines of the American Association for the Study of Liver Diseases.

Hepatocellular carcinoma is a malignancy that predominantly occurs in the setting of cirrhosis. Its incidence is rising worldwide. Hepatocellular carcinoma differs from most malignancies because it is commonly diagnosed on the basis of imaging features alone, without histologic confirmation. The guidelines from the American Association for the Study of Liver Diseases (AASLD) are a leading statement for the diagnosis and staging of hepatocellular carcinoma, and they have recently been updated, incorporating several important changes. AASLD advocates the use of the Barcelona Clinic Liver Cancer (BCLC) staging system, which combines validated imaging and clinical predictors of survival to determine stage and which links staging with treatment options. Each stage of the BCLC system is outlined clearly, with emphasis on case examples. Focal liver lesions identified at ultrasonographic surveillance in patients with cirrhosis require further investigation. Lesions larger than 1 cm should be assessed with multiphasic computed tomography or magnetic resonance imaging. Use of proper equipment and protocols is essential. Lesions larger than 1 cm can be diagnosed as hepatocellular carcinoma from a single study if the characteristic dynamic perfusion pattern of arterial hyperenhancement and venous or delayed phase washout is demonstrated. If the imaging characteristics of hepatocellular carcinoma are not met, the alternate modality should be performed. Biopsy should be used if neither modality is diagnostic of hepatocellular carcinoma. Once the diagnosis has been made, the cancer should be assigned a BCLC stage, which will help determine suitable treatment options. Radiologists require a systematic approach to diagnose and stage hepatocellular carcinoma with appropriate accuracy and precision.

Evaluation of the particulate concentration in a gelatin-based phantom for sonographically guided lesion biopsy.

OBJECTIVES: The purpose of this study was to determine the particulate concentration in a gelatin-based ultrasound phantom for lesion biopsy at 6 cm in depth to reduce visualization of the biopsy needle in the near field, simulating subcutaneous fat and tissue echogenicity, and maintain target lesion visualization. METHODS: Four gelatin-based phantoms with cornstarch at concentrations of 4, 8, 12, and 16 g/L and an anechoic gelatin target at 7 cm in depth were rated on a 5-point scale by readers for visibility of the target lesion, similarity of near-field to abdominal subcutaneous fat echogenicity, and visibility of a 22-gauge spinal needle in the phantom. A timed sonographically guided localization task was performed on the anechoic target by 4 radiology residents using the 22-gauge spinal needle. Results were analyzed by comparative statistical analysis. RESULTS: An increasing particulate concentration did not alter the similarity of near-field to abdominal subcutaneous fat echogenicity (P = .6) but did significantly reduce visibility of the anechoic target at a cornstarch concentration of 16 g/L (P = .04) and the 22-gauge needle at 12 g/L (P = .03). Decreased visualization of the needle or target lesion did not affect the time for needle localization of the anechoic target (P = .96). CONCLUSIONS: The optimal ultrasound phantom cornstarch concentration was 12 g/L to reduce visualization of the spinal needle, simulating subcutaneous fat echogenicity while maintaining target lesion visualization.

Patient radiation dose during angiography and embolization for abdominal hemorrhage: the influence of CT angiography, fluoroscopy system, patient and procedural variables.

BACKGROUND: Angiography and embolization (AE) is a lifesaving, high radiation dose procedure for treatment of abdominal arterial hemorrhage (AAH). Interventional radiologists have utilized pre-procedure CT angiography (CTA) and newer fluoroscopic systems in an attempt to reduce radiation dose and procedure time. PURPOSE: To study the factors contributing to the radiation dose of AE for AAH and to compare to the reference standard. MATERIALS AND METHODS: This retrospective single-centre observational cohort study identified 154 consecutive AE procedures in 138 patients (median age 65 years; interquartile range 54-77; 103 men) performed with a C-arm fluoroscopic system (Axiom Artis DTA or Axiom Artis Q (Siemens Healthineers)), between January 2010 and December 2017. Parameters analysed included: demographics, fluoroscopy system, bleeding location, body mass index (BMI), preprocedural CT, air kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of digital subtraction angiography (DSA) runs. Factors affecting dose were assessed using Mann-Whitney U, Kruskal-Wallis one-way ANOVA and linear regression. RESULTS: Patients treated with the new angiographic system (NS) had a median PKA, median Ka,r, Q3 PKA and Q3 Ka,r that were 74% (p < 0.0005), 66%(p < 0.0005), 55% and 52% lower respectively than those treated with the old system (OS). This dose reduction was consistent for each bleeding location (upper GI, Lower GI and extraluminal). There was no difference in PKA (p = 0.452), Ka,r (p = 0.974) or FT (p = 0.179), between those who did (n = 137) or did not (n = 17) undergo pre-procedure CTA. Other factors significantly influencing radiation dose were: patient BMI and number of DSA runs. A multivariate model containing these variables accounts for 15.2% of the variance in Ka,r (p < 0.005) and 45.9% of the variance of PKA (p < 0.005). CONCLUSION: Radiation dose for AE in AAH is significantly reduced by new fluoroscopic technology. Higher patient body mass index is an independent key parameter affecting patient dose. Radiation dose was not influenced by haemorrhage site or performance of pre-procedure CTA.

Scintigraphic assessment of arterial embolism at mixed thrombin and technetium 99m injection therapy for femoral pseudoaneurysms.

BACKGROUND: Clinically evident arterial thrombosis is rare following thrombin injection therapy for femoral pseudoaneurysm. However, it is unclear to what extent injected thrombin may pass to the ipsilateral lower limb arteries. AIMS: To assess if technetium 99m injected at the time of thrombin injection for femoral artery pseudoaneurysm therapy passes into the adjacent lower limb arteries. METHODS: This was a prospective trial with institutional review board approval. Four consecutive patients with common femoral pseudoaneurysms and failed manual compression were enrolled. Under real-time colour flow doppler ultrasound, a mixture of 1000 IU thrombin and approximately 200 MBq technetium 99m was injected in 0.1-mL doses into the pseudoaneurysm until thrombosis occurred. Gamma camera imaging of the syringe before injection, the injected groin after thrombosis and the syringe after injection were performed. Analysis of the gamma camera information was performed to determine the amount of technetium 99m deposited in the arterial tree. RESULTS: All the procedures were technically successful. A mean of 33% (range 3-50%; SD 21) of the administered technetium 99m dose was deposited in the arterial circulation during pseudoaneurysm therapy. No clinically evident arterial thrombosis was identified. CONCLUSION: Technetium 99m is routinely deposited in the arterial circulation following injection of a mixture of thrombin and technetium for therapy of common femoral artery pseudoaneurysms. This suggests that arterial passage of thrombin is more common than clinically evident.

Conventional angiography findings in hemodynamically unstable patients with acute abdominal hemorrhage and a negative CT bleeding study.

BACKGROUND: CT bleeding study (CTA) is regularly requested in acute abdominal haemorrhage (AAH) with haemodynamic instability by clinical teams and interventional radiologists because CTA can; detect arterial bleeding at low rates of hemorrhage, accurately localize the bleeding point and characterize the etiology. How best to manage an unstable patient who has an AAH with a haematoma and no acute vascular findings on CTA represents a difficult clinical scenario for treating physicians and Interventional Radiologists. PURPOSE: To review the conventional angiography (CA) findings and clinical outcome of hemodynamically unstable patients with AAH who had a preceding negative CTA. MATERIALS AND METHODS: All patients who were hemodynamically unstable and underwent CTA and CA for acute arterial abdominal hemorrhage at our institution between 01/01/2010 and 31/12/2017 were identified. Patients with obstetric, penetrating trauma, abdominal aortic or venous sources of hemorrhage were excluded. Patients who had a negative CTA before CA were included. Patient medical records were reviewed for clinical outcome. RESULTS: In the study period 160 hemodynamically unstable patients underwent 178 CA procedures. 155 CA procedures were preceded by CTA. 141 CTAs demonstrated active bleeding or an abnormal artery. 14 CTAs in 13 patients demonstrated hematoma but no acute bleeding (mean age = 56-years; M:F, 12:1). Eight of the 14 CA studies demonstrated: active bleeding (n = 4), pseudoaneurysm (n = 1) or a truncated artery (n = 3). Cases of renal hemorrhage demonstrated a significantly higher proportion of false negative CTA studies (36%). Selective (n = 8) or empiric (n = 4) embolization was performed in twelve cases. All patients stopped bleeding and there were no mortalities. CONCLUSION: In a cohort of hemodynamically unstable patients, 57% (8/14) of cases with no acute vascular findings on CTA demonstrated a source of hemorrhage on CA. The false negative rate of CTA was significantly higher for renal tract hemorrhage compared to other sites of bleeding.

Comparison of the recovery and G2 filter as retrievable inferior vena cava filters.

PURPOSE: To compare the technical success of the Recovery and G2 filters as retrievable inferior vena cava (IVC) filters. MATERIALS AND METHODS: Recovery (n = 128) and G2 (n = 113) filters were placed in the IVCs of 241 patients with the intent of retrieval. The referring physician and/or patient were contacted at 6-month intervals to ensure filter retrieval when indicated. The Recovery and G2 filter groups were compared regarding technical success of filter placement, technical success of attempted retrieval, filter tilt, filter migration, filter fracture, and filter efficacy. RESULTS: Filter placement was technically successful in 95% of Recovery filters (n = 122) and 100% of G2 filters (n = 113). Recovery filter retrieval was attempted in 55% of patients (n = 71) at a mean of 228 days (range, 0-838 d) after filter placement. G2 filter retrieval was attempted in 55% of patients (n = 62) at a mean of 230 days (range, 7-617 d) after filter placement. Technical success rates of filter retrieval were 94% (n = 67) and 97% (n = 60) in the Recovery and G2 filter groups, respectively. The G2 filter group had significantly fewer cases of (i) filter tilt at placement, (ii) filter tilt at attempted retrieval, and (iii) filter fracture than the Recovery filter group. In the G2 filter group, there was a significantly higher technical success rate of filter placement and there were more cases of caudal filter migration than in the Recovery filter group. CONCLUSIONS: Compared with the Recovery filter, the G2 filter is associated with significantly less filter fracture and tilt, greater technical success of filter placement, and more caudal filter migration.

Thirty years' experience with balloon dilation of benign postoperative biliary strictures: long-term outcomes.

PURPOSE: To determine the effectiveness of percutaneous balloon dilation of benign postoperative biliary strictures. MATERIALS AND METHODS: We received approval from our institutional review board to undertake this retrospective HIPAA-compliant study, and informed consent was waived. From April 1, 1977, to April 1, 2007, percutaneous biliary balloon dilation (PBBD) was performed in 85 patients with benign biliary strictures. In the 75 patients with follow-up (31 male, 44 female; mean age, 56 years; mean follow-up, 8 years), 205 PBBD procedures were performed during 112 treatments of 84 biliary strictures. PBBD of the stricture was performed with a noncompliant balloon (8-12-mm diameter). PBBD procedures were repeated at 2- to 14-day intervals until cholangiography demonstrated free drainage of contrast material to the bowel and no residual stenosis. An internal-external biliary drain was left in situ for a mean of 14-22 days and removed after a clinical trial of catheter clamping and a normal cholangiogram. RESULTS: All procedures were technically successful, and 52, 11, 10, and two patients underwent a total of one, two, three, and four PBBD treatments, respectively. Four of 205 procedures (2%) led to major complications: two subphrenic abscesses, one hepatic arterial pseudoaneurysm, and one case of hematobilia treated with transfusion. Six patients died from unrelated causes and three from hepatitis C-related liver failure. The probability of a patient not developing clinically significant restenosis at 5, 10, 15, 20, and 25 years was 0.52, 0.49, 0.49, 0.41, and 0.41, respectively, after the first PBBD treatment and 0.43, 0.30, 0.20, 0.20, and 0.20, respectively, after the second PBBD treatment. No significant difference was found in the rate of clinically significant restenosis after the first PBBD between strictures at anastomotic and nonanastomotic sites (P = .75). During the follow-up period, 56 of 75 patients (75%) had successful management with PBBD. CONCLUSION: PBBD of benign strictures demonstrates long-term effectiveness. No significant difference was found in the rate of clinically significant restenosis after PBBD of biliary strictures at anastomotic and nonanastomotic sites.

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

PURPOSE: We aimed to compare the overall (OS) and disease-free survival (DFS) of patients undergoing orthotopic liver transplant (OLT) for hepatocellular carcinoma who did and did not have neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization (DEB-TACE). METHODS: This is a retrospective study of 94 patients with HCC transplanted between 2000 and 2014 in a single tertiary center. Pre- and postoperative features, DFS and OS were compared between patients who received pre-OLT DEB-TACE (n=34, DEB-TACE group) and those who did not (n=60, non-TACE group). Radiologic and histologic response to neoadjuvant treatment as well as its complications were also studied. RESULTS: There were no significant differences in post-transplantation DFS and OS rates between groups (5-year DFS: 70% in DEB-TACE group vs. 63% in non-TACE group, P = 0.454; 5-year OS: 70% in DEB-TACE group vs. 65% in non-TACE group, P = 0.532). The DEB-TACE group had longer OLT waiting time compared with the non-TACE group (110 vs. 72 days; P = 0.01). On univariate and multivariate analyses, alpha-fetoprotein (AFP) levels >500 ng/mL prior to OLT were associated with decreased OS and DFS regardless of neoadjuvant approach (hazard ratio of 6, P = 0.001 and 5.5, P = 0.002, respectively). CONCLUSION: Patients who underwent neoadjuvant DEB-TACE and OLT for hepatocellular carcinoma had no statistically different OS or DFS at 3 and 5 years from patients undergoing OLT alone.

Midterm Analysis of Survival and Cause of Death Following Endovascular Abdominal Aortic Aneurysm Repair.

PURPOSE: To assess rates of complications, secondary interventions, survival, and cause of death following endovascular abdominal aortic aneurysm (AAA) repair over a 10-year period. MATERIALS AND METHODS: Single-institution retrospective cohort study of all patients undergoing primary endovascular aortic aneurysm repair (EVAR) between July 2006 and June 2015. The population constituted 175 patients with 163 fusiform and 12 saccular AAAs. Of these, 149 (85%) were male, with mean age 75.4 (±7.1) years. Patients were followed up until June 30, 2016. Cause of death was determined from the national death register. RESULTS: Mean follow-up was 34.4 (±24.4) months. The secondary intervention rate was 9.7%, and there were 4 aneurysm ruptures (0.8% annual incidence). Thirty-day mortality was 0.6%. Survival at 1, 3, and 5 years was 93.1%, 84%, and 64.9%, respectively. Forty-eight patients died during follow-up, 3 secondary to rupture, leading to overall and aneurysm-related death rates of 9.7 and 0.6 per 100 person-years. All other deaths were due to nonaneurysm causes, most commonly cardiovascular (n = 15), pulmonary (n = 13), and malignancy (n = 9). Baseline renal impairment ( P < .001), ischemic heart disease ( P < .05), age greater than 75 years ( P < .05), and urgent/emergency EVAR were associated with inferior long-term survival. Type II endoleak negatively influenced fusiform aneurysm sac regression ( P = .02), but there was no association between survival and occurrence of any complication or secondary intervention. CONCLUSION: The majority of deaths during medium-term follow-up post-EVAR are due to nonaneurysm-related causes. Survival is determined by the following baseline factors: renal impairment, ischemic heart disease, advanced age, and the presence of a symptomatic/ruptured aneurysm.

MRI features after radiofrequency ablation of osteoid osteoma with cooled probes and impedance-control energy delivery.

OBJECTIVE: The purposes of our study were to determine the temporal changes in MR signal in bone after radiofrequency ablation of osteoid osteoma and the size of the zone of marrow signal change produced by the radiofrequency technique and to compare the size of the zone with published data for radiofrequency ablation with manual-control protocols. MATERIALS AND METHODS: Radiofrequency ablation was performed in 10 patients with a clinical and radiologic diagnosis of osteoid osteoma. A cooled radiofrequency probe was inserted in the nidus. Twelve minutes of radiofrequency energy was applied from a 200-W radiofrequency generator in an impedance-control setting. MRI with multiplanar turbo spin-echo T1-weighted and STIR sequences was performed at 1, 7, and 28 days after the procedure in seven patients. The three remaining patients had follow-up imaging at 28 days only. The images were reviewed by two radiologists who categorized the imaging features and measured the marrow zone of signal alteration when visible. The size of the zone of marrow signal change produced by the radiofrequency technique was compared with published data for radiofrequency ablation with manual-control protocols. RESULTS: A 1-mm band of homogeneous altered marrow signal distributed symmetrically parallel to the entire probe tract was seen earliest, at 1 day, in the femoral neck lesion treated with the 2-cm probe. The band was low signal on the T1 sequence and high signal on the STIR sequence, and the diameter of the zone was 27 mm. By 7 days, five of the seven treated bones showed a band of marrow signal alteration. By 28 days, all 10 treated bones had a band of marrow signal alteration. The interband distance at 90 degrees to the probe measured on STIR images at 28 days was a mean of 20.9 mm (confidence interval, 16.1-25.7 mm [p < 0.05]; range +/- measurement error, 10.5-35 +/- 1.64 mm) with a 1-cm probe and 30.5 mm (measurement error, +/- 0.78 mm) on T1 images without contrast material when a 2-cm exposed-tip probe was used. Higher-output generators with impedance-control software and internally cooled radiofrequency probes with longer exposed tips produce larger zones of marrow signal change than expected with manual-control protocols. CONCLUSION: MRI allows detection of temporal marrow signal change after radiofrequency ablation. The marrow signal change with a high-energy delivery protocol is larger than manual-control protocols.

Fabrication and assessment of 3D printed anatomical models of the lower limb for anatomical teaching and femoral vessel access training in medicine.

For centuries, cadaveric dissection has been the touchstone of anatomy education. It offers a medical student intimate access to his or her first patient. In contrast to idealized artisan anatomical models, it presents the natural variation of anatomy in fine detail. However, a new teaching construct has appeared recently in which artificial cadavers are manufactured through three-dimensional (3D) printing of patient specific radiological data sets. In this article, a simple powder based printer is made more versatile to manufacture hard bones, silicone muscles and perfusable blood vessels. The approach involves blending modern approaches (3D printing) with more ancient ones (casting and lost-wax techniques). These anatomically accurate models can augment the approach to anatomy teaching from dissection to synthesis of 3D-printed parts held together with embedded rare earth magnets. Vascular simulation is possible through application of pumps and artificial blood. The resulting arteries and veins can be cannulated and imaged with Doppler ultrasound. In some respects, 3D-printed anatomy is superior to older teaching methods because the parts are cheap, scalable, they can cover the entire age span, they can be both dissected and reassembled and the data files can be printed anywhere in the world and mass produced. Anatomical diversity can be collated as a digital repository and reprinted rather than waiting for the rare variant to appear in the dissection room. It is predicted that 3D printing will revolutionize anatomy when poly-material printing is perfected in the early 21st century.

Transrectal Ultrasound Guided Biopsy of the Prostate: Is the Information Accessible, Usable, Reliable and Readable?

BACKGROUND/AIMS: To evaluate the accessibility, usability, reliability and readability of Internet information regarding transrectal ultrasound (TRUS) guided biopsy of the prostate. MATERIALS AND METHODS: The terms "prostate biopsy", "TRUS biopsy" and "transrectal ultrasound guided biopsy of the prostate" were separately entered into the each of the top 5 most accessed Internet search engines. Websites were evaluated for accessibility, usability and reliability using the LIDA tool - a validated tool for the assessment of health related websites. Website readability was assessed using the Flesch Reading Ease Score and the Flesch Kincaid Grade Level. RESULTS: Following the application of exclusion criteria, 82 unique websites were analyzed. There was a significant difference in scores depending on authorship categories (p ≤ 0.001), with health related charity websites scoring highest (mean 122.29 ± 13.98) and non-academic affiliated institution websites scoring lowest (mean 87 ± 19.76). The presence of advertisements on a website was associated with a lower mean overall LIDA tool score (p = 0.024). Only a single website adhered to the National Institutes for Health recommendations on readability. CONCLUSIONS: This study demonstrates variability in the quality of information available to Internet users regarding TRUS biopsies. Collaboration of website design and clinical acumen are necessary to develop appropriate websites for patient benefit.

Large-bore gastrostomy feeding tube insertion by a pull technique using a snare.

We describe a series of three patients who had fluoroscopic-guided placement of a large-bore gastrostomy tube using a pull technique and a large snare placed via a nasogastric or orogastric tube.

Absolute alcohol embolization of sporadic angiomyolipoma.

Angiomyolipoma is a benign hamartoma. Seventy percent of angiomyolipomas occur sporadically in the general population and the remainder are associated with a syndrome. Of patients with tuberous sclerosis, 60 to 80% have an angiomyolipoma. Sporadic angiomyolipomas tend to be single and occur in an older age group. In tuberous sclerosis, the lesions are usually bilateral and multiple. Therapy is indicated when there are symptoms or when the lesion is greater than 4 cm. Criteria for further embolization include growth of the lesion by 2 cm at annual follow-up computed tomography and presentation with acute hemorrhage. We describe a case of a sporadic asymptomatic angiomyolipoma treated with absolute alcohol embolization.

Feasibility and safety of infracolic fluoroscopically guided percutaneous radiologic gastrostomy.

We study the feasibility and safety of infracolic fluoroscopically guided percutaneous gastrostomy when patient anatomy prevents conventional supracolic puncture. From September 2004 to April 2007, 508 gastrostomy and gastrojejunostomy catheters were inserted in a single institution, and in six patients, the position of the transverse colon prevented conventional supracolic puncture. All were male, with a mean age of 57 years. Four patients had head and neck cancer and two had neurologic conditions. With fluoroscopic guidance, a 14-F gastrostomy tube was inserted with T-fastener gastropexy caudal to the colon. The medical records of patients treated with this technique were reviewed for demographics, indication, technique, complications, function of gastrostomy, timing of removal of the gastrostomy, and subsequent hospital admissions. All procedures were technically successful and there was no procedure-related morbidity or mortality. The mean follow-up was 16 months (range, 7-25 months) and the mean duration of therapy was 7 months. Five patients had their gastrostomy removed after clinical improvement and one of these patients had a gastrostomy reinserted cephalic to the colon after recurrence of head and neck cancer. Two patients died of disease progression and one still had the gastrostomy in position. No patient was subsequently admitted for a complication of the technique or catheter malfunction. In conclusion, infracolic percutaneous radiologic gastrostomy with gastropexy is feasible in patients without an access route cephalic to the transverse colon.

Prostate biopsy after ano-rectal resection: value of CT-guided trans-gluteal biopsy.

We describe our single-institutional experience with computed tomography (CT)-guided percutaneous transgluteal biopsy of the prostate in patients in whom transrectal ultrasound-guided biopsy is precluded by prior ano-rectal resection. Between March 1995 and April 2007, 22 patients had 34 prostate biopsies (mean age 68; mean PSA 29 ng/ml; mean follow-up 6.1 years). The charts of patients who had transgluteal biopsy were reviewed for demographic, complications and pathology. Ninety-five percent (21/22) of primary biopsies were diagnostic. Of the 21 diagnostic biopsies, 11 were positive for prostate cancer and ten were definitive benign samples. Seventy-three percent (8/11) of the patients had progressive PSA elevation that mandated 11 further prostate biopsies. Six patients had a second biopsy, one patient had a third and one patient had a fourth biopsy. Among patients who had serial biopsies, 38% (3/8) had prostate cancer. No complications or death occurred. A malignant biopsy was not significantly associated with core number (P = 0.58) or a high PSA level (P = 0.15). CT-guided transgluteal biopsy of the prostate is safe and effective.

Antibiotic prophylaxis for percutaneous radiologic gastrostomy and gastrojejunostomy insertion in outpatients with head and neck cancer.

PURPOSE: To determine the effect of antibiotic prophylaxis on the postprocedural infection rate after fluoroscopically guided percutaneous radiologic gastrostomy and gastrojejunostomy with gastropexy performed as an outpatient procedure in ambulatory patients with head and neck cancer. MATERIALS AND METHODS: Medical and imaging records of all outpatients with head and neck cancer referred for gastrostomy or gastrojejunostomy from February 2003 to November 2004 were retrospectively reviewed. A 14-F percutaneous gastrostomy was inserted through the anterior abdominal wall after T-fastener gastropexy. Fifty-seven patients (36 men; mean age, 57.2 years; age range, 17-76 y) had 53 percutaneous radiologic gastrostomies and four percutaneous radiologic gastrojejunostomies. Mean follow-up was 27 weeks (range, 4-62 weeks). Thirty-seven patients received antibiotic prophylaxis with 1 g cefazolin intravenously and twice-daily cephalexin 500 mg for 5 days orally or via gastrostomy (n = 35) or clindamycin 600 mg intravenously and 600 mg twice daily orally or via gastrostomy for 5 days (n = 2). RESULTS: Ten minor postprocedural complications occurred in 8 patients (14%). There was a 15% peristomal infection rate (n = 3) in patients who did not receive antibiotic prophylaxis; none occurred in those who received antibiotic prophylaxis. There were significantly fewer infections in the group that received antibiotic prophylaxis (P = .039). No major complications or deaths occurred. CONCLUSIONS: Administration of prophylactic antibiotics for percutaneous radiologic gastrostomy placement reduces peristomal infection in patients with head and neck cancer.