Novel colonoscopy-assisted percutaneous radiologic gastrostomy technique for large bowel mobilization in anterior gastrocolic interposition - A case report

Purpose Gastrostomy remains the preferred route for long-term enteral nutrition when oral feeding is challenging. This procedure may be performed endoscopically, surgically, or fluoroscopically via percutaneous radiologic gastrostomy (PRG), which is gaining widespread popularity. However, anterior gastrocolic interposition, in which the colon overlies the stomach, often precludes safe PRG creation. This obstructs percutaneous access and may result in complications such as transcolonic tube insertion. Various alternatives, such as infracolic approaches, have been suggested. However, these approaches still carry a risk of bleeding from middle colic artery injury, bowel ischemia, and late-term bowel entrapment or obstruction due to transverse mesocolon tethering. In this case report, we present a novel approach to PRG creation in cases of colonic interposition using endoscopic colonic manipulation to mitigate these complications. Material and methods An elderly male patient with tetraplegia and inadequate oral feeding required long-term enteral nutrition. As he was a poor surgical candidate with a high bleeding risk and multiple comorbidities, he was planned for PRG creation. However, the transverse colon overlaid the stomach anteriorly, making gastric access challenging. Results A combined procedure involving interventional radiology and gastroenterology was performed. A colonoscope was used to displace the colon inferiorly, with the resulting position confirmed by cone-beam CT. Technical success was achieved without post-procedural complications. Conclusion We describe a feasible multidisciplinary technique using colonoscopy to manage colonic interposition during PRG, with successful technical outcomes. This novel approach presents a viable alternative for patients with challenging anatomy who are unfit for surgical gastrostomy.