Introduction: Gastrostomy insertion provides essential long-term nutritional support for patients due to neurological or congenital conditions. While common in both adults and children, pediatric patients present unique challenges requiring specialized techniques. This article highlights the differences between pediatric and adult gastrostomy procedures and explores how to optimize outcomes . Anatomical Considerations: Pediatric patients have smaller abdominal cavities, thinner abdominal walls, and smaller stomachs, increasing the risk of injury during gastrostomy. These factors necessitate smaller instruments and specialized techniques. The pliability of the pediatric abdominal wall makes securing the gastrostomy tube crucial to prevent dislodgement or leakage. Ensuring accurate tube placement is essential to avoid trauma and complications. Physiological Differences: Children have higher metabolic rates and rapid growth, affecting their nutritional needs and healing after surgery. Considerations include complications such as reflux or poor feed tolerance. Smaller stomach volume also requires careful tube size and placement. Technique Modifications: Percutaneous Endoscopic Gastrostomy (PEG): Adjusted for smaller anatomy. Radiologically Inserted Gastrostomy (RIG): Ideal for children with complex surgical histories; guided placement reduces injury risk, though minimizing radiation exposure is vital. Laparoscopic Gastrostomy: Used when direct visualization is needed, particularly for complex cases. Radiological considerations include fluoroscopic visualization of the stomach bubble and liver ultrasound to assess organ positioning. Postoperative Considerations: Children are more prone to complications such as infection, leakage, and tube dislodgement. Educating caregivers on tube care and recognizing complications is critical to ensure proper nutrition and tube functionality. Optimizing Outcomes: A multidisciplinary approach involving pediatric surgeons, gastroenterologists, and radiologists is essential. Preoperative planning must address anatomical and medical complexities, while postoperative care should include ongoing monitoring and adjustments as the child grows. Conclusion: Pediatric gastrostomy requires adaptations of adult techniques to account for children’s anatomical and physiological differences. A multidisciplinary approach with careful planning and specialized care is vital for minimizing complications and ensuring successful outcomes. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Arshad Wajiha

Keywords: Interventional Radiology

Introduction: Artificial intelligence (AI) is set to transform pediatric interventional radiology (PIR) by enhancing precision, improving diagnostics, and streamlining workflows. Given the complexities of smaller anatomy and higher risks in pediatric patients, AI's integration into imaging and procedural planning will significantly support growth and improve outcomes in the next decade. This abstract outlines key areas where AI will impact PIR. Key Areas: Enhanced Imaging and Diagnosis: AI algorithms will enable faster and more accurate identification of anatomical structures and abnormalities in pediatric patients. Automated image processing can highlight critical features, assisting interventional radiologists in making informed decisions. This technology will provide detailed anatomical maps to guide minimally invasive interventions. Procedure Optimization: AI will enhance procedure planning and execution by predicting complications and recommending optimal techniques. AI-powered navigation systems integrated with real-time imaging will assist radiologists in navigating complex anatomical pathways, reducing procedure times and minimizing radiation exposure. Automated measurement tools will further personalize treatment. Improved Decision-Making: AI can analyze data from previous procedures to support decision-making, helping radiologists choose the best treatment based on predictive analytics. Machine learning models can identify trends and suggest personalized interventions, standardizing best practices and improving success rates in pediatric interventions. Workflow Efficiency: AI-driven automation will streamline tasks such as scheduling, imaging analysis, and report generation, allowing radiologists to focus more on patient care. By predicting resource needs and optimizing timing, AI will enhance workflow efficiency and facilitate multidisciplinary collaboration. Education and Training: AI will revolutionize education in pediatric interventional radiology. Virtual reality (VR) and AI-based simulation platforms will enable trainees to practice complex procedures in realistic environments, providing real-time feedback and personalized learning pathways. Conclusion: AI’s integration into pediatric interventional radiology will enhance imaging, optimize procedures, and streamline workflows. By leveraging AI’s capabilities, PIR can achieve greater precision, reduce risks, and improve outcomes for pediatric patients, driving growth and advancement in the field. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Arshad Wajiha

Keywords: Interventional Radiology

Introduction: Children with esophageal atresia, tracheoesophageal fistulas, and Hirschsprung disease often undergo early invasive surgeries to correct these anatomical malformations, ensuring adequate nutritional intake. However, over time, post-surgical anastomotic strictures can develop, leading to mechanical obstructions that impair swallowing or defecation. Traditional treatment for such strictures often involves re-do surgery, but this carries significant risks and recovery time. Our study explores the efficacy of a combined radiological and surgical approach to manage these strictures, aiming to reduce the need for further invasive surgeries. Methods: Between September 2022 and May 2023, we performed six procedures involving pediatric patients with symptomatic post-anastomotic strictures (five esophageal, one colorectal). Each patient presented with symptoms suggestive of mechanical obstruction, such as dysphagia or difficulty passing stool. Under general anesthesia, both a surgical consultant and an interventional radiologist performed the procedures. Initial endoscopy was followed by fluoroscopic guidance via a 0.018 wire introduced through the endoscope. Balloon dilatation, using a range of balloon sizes (10mm–27mm), was performed, and the outcomes were assessed via pre- and post-dilatation fluoroscopic imaging with water-soluble contrast. Repeat endoscopy was used to confirm the efficacy of the dilatation. Results: Of the six cases, five were successfully treated with balloon dilatation, with no immediate need for further invasive surgery. One case, although initially successful, required subsequent surgical intervention due to recurrent stricture. Post-procedural imaging and endoscopy confirmed patency in the remaining cases, with significant symptom improvement. Discussion: This study highlights the efficacy of a combined radiological and surgical approach in managing post-anastomotic strictures. The use of intraoperative endoscopic and fluoroscopic correlation allowed for precise dilatation, reducing the likelihood of recurrence and avoiding immediate re-do surgeries. Conclusions: A combined surgical and radiological approach to post-anastomotic strictures offers a less invasive, resource-efficient, and effective alternative to re-do surgery. The success rate of 83% demonstrates that balloon dilatation under fluoroscopic and endoscopic guidance is a valuable adjunct to conventional surgical management of these conditions. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Arshad Wajiha, Igwe Chukwuemeka

Keywords: Interventional Fluoroscopic