title: Placement of PEG tubes through previously placed self-expanding esophageal metal stents.
abstract: BACKGROUND
  Self-expanding metal stents are frequently used to palliate patients with malignant dysphagia and close tracheoesophageal fistulae. Despite proper stent positioning and deployment, in a subset of patients there is no improvement in dysphagia, closure of tracheoesophageal fistulae, or resolution of anorexia. Such patients may require a PEG tube. It has been suggested that PEG placement through a preexisting esophageal stent is problematic because of the risks of gastrostomy tube impaction within the stent and resultant stent migration.
  
  
  METHODS
  Case records were retrospectively reviewed of 9 consecutive patients with indwelling esophageal self-expanding metal stents undergoing attempted PEG.
  
  
  METHODS
  PEG tube placement was successful in all patients. In 1 patient, the stent migrated distally into the stomach during PEG placement. This was managed endoscopically without further complication.
  
  
  CONCLUSIONS
  PEG placement in patients with previously placed esophageal self-expanding metal stents is a relatively safe and feasible procedure, although stent migration may occur.
authors.affiliation: Departments of Internal Medicine, Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Adler
authors.forename: T H
authors.initials: TH
authors.lastname: Baron
authors.forename: W
authors.initials: W
authors.lastname: Geels
authors.forename: D E
authors.initials: DE
authors.lastname: Morgan
authors.forename: K E
authors.initials: KE
authors.lastname: Monkemuller
mesh_terms: D000368:Aged; D000855:Anorexia / Q000628:therapy; D003680:Deglutition Disorders / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D014138:Tracheoesophageal Fistula
chemical_list: D008670:Metals