case_images: PMC11835415_01
case_images: Axial CT showing narrow window where stomach abuts the abdominal wall for traditional percutaneous endoscopic gastrostomy placement. The red arrow indicated where the stomach abuts the abdominal wall.
case_images: crg-2025-0019-0001-542809_F01.jpg
case_images: PMC11835415_01_crg-2025-0019-0001-542809_F01.jpg
case_images: F1
case_images: CT scans consistently showed a very narrow (2 x 2cm) window in the left upper quadrant through which the stomach could potentially be accessed without traversing nearby intestines (Fig. 1).
case_images: Oblique fluoroscopic image showing endoscope used to push stomach against abdominal wall (white arrow), with percutaneous needle introduced to access stomach (red arrow).
case_images: crg-2025-0019-0001-542809_F02.jpg
case_images: PMC11835415_01_crg-2025-0019-0001-542809_F02.jpg
case_images: F2
case_images: Using real time steep oblique and true-lateral images, a needle was placed just anterior to the endoscope (Fig. 2).
case_images: Fluoroscopic image showing the introducer (white arrow) in the stomach, adjacent to the curled endoscope (red arrow). The blue arrow demonstrates the nasogastric tube within the stomach.
case_images: crg-2025-0019-0001-542809_F03.jpg
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case_images: F3
case_images: After IR gained gastric access and safely introduced a guidewire (Fig. 3), standard endoscopic placement of the gastrostomy tube was performed by the treatment team.
case_images: Post-hybrid gastrostomy placement axial CT showing successful placement (red arrow) in the previously identified narrow window.
case_images: crg-2025-0019-0001-542809_F04.jpg
case_images: PMC11835415_01_crg-2025-0019-0001-542809_F04.jpg
case_images: F4
case_images: Post-procedural CT scan confirmed appropriate positioning, and revealed only millimeters of space between the gastrostomy and the surrounding intestines after the stomach was desuflated (Fig. 4, 5).
case_images: Sagittal CT showing the steep angle (red arrow) required to access the stomach for hybrid gastrostomy.
case_images: crg-2025-0019-0001-542809_F05.jpg
case_images: PMC11835415_01_crg-2025-0019-0001-542809_F05.jpg
case_images: F5
case_images: Post-procedural CT scan confirmed appropriate positioning, and revealed only millimeters of space between the gastrostomy and the surrounding intestines after the stomach was desuflated (Fig. 4, 5).