A nonsurgical technique to create an esophagostomy for difficult cases of percutaneous endoscopic gastrostomy.
BACKGROUND
We developed a minimally invasive technique of esophagostomy called percutaneous transesophageal gastrotubing (PTEG) using a rupture-free balloon (RFB) for enteral nutrition and drainage as well as percutaneous endoscopic gastrostomy (PEG). PTEG using RFB allows surgeons to create a nonsurgical esophagostomy even in difficult cases of PEG (i.e., total gastrectomized patients and massive ascites).


METHODS
To create the PTEG, a RFB is inserted into the esophagus through the nose and inflated. The RFB is punctured with a needle at the left neck under ultrasonographic vision. A guidewire is inserted through the needle, followed by dilatation of the punctured site using a dilator with sheath. Finally, the tube is inserted into the gastrointestinal tract and the sheath is peeled off.


RESULTS
From January 1998 to June 2002, we treated 115 patients using PTEG with a RFB and there were no major complications. Therapeutic results are as good as those for PEG and it took approximately 15 min to perform.


CONCLUSIONS
PTEG with RFB is as safe as PEG and is simple and less invasive. It can be used in some cases for which PEG is contraindicated.
Department of Surgery, Institute of Geriatrics, Tokyo Women's Medical University, 2-15-1-22F, Shibuya, Shibuya-Ku, Tokyo 150-0002, Japan. hi-oishi@ah.twmu.ac.jp
H
H
Oishi
H
H
Shindo
N
N
Shirotani
S
S
Kameoka
D002404:Catheterization; D000075202:Contraindications; D004322:Drainage; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007440:Intubation / Q000379:methods; D008297:Male; D016896:Treatment Outcome