title: Diagnostic and therapeutic endoscopy through the gastrostomy site.
abstract: We report a successful diagnostic and therapeutic endoscopy through the gastrostomy site in two patients in whom conventional antegrade upper endoscopy was not possible. In one, the endoscopic and histologic diagnosis of a completely obstructing malignant lesion in the upper esophagus was possible by retrograde intubation using a bronchoscope. In the other, the gastrostomy site was used to gain access and assist in the placement of a jejunostomy tube. We describe a technique to help circumvent the lack of air insufflation with the bronchoscope. Both endoscopies were carried out without the need for drugs for conscious sedation. This percutaneous route, through a gastrostomy site, in the technique described by us uses a readily available endoscope in any hospital setting, does not need conscious sedation, and does not need dilation of the stoma site, allowing access to the gastrointestinal tract for diagnostic and therapeutic purposes.
authors.affiliation: Department of Medicine, Carl T. Hayden VA Medical Center, Phoenix, Arizona 85012, U.S.A.
authors.forename: F C
authors.initials: FC
authors.lastname: Ramirez
authors.forename: A J
authors.initials: AJ
authors.lastname: Grade
authors.forename: D J
authors.initials: DJ
authors.lastname: Drewitz
authors.forename: M S
authors.initials: MS
authors.lastname: Shaukat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male