Percutaneous transesophageal gastrostomy tube for decompression of malignant obstruction: report of the first case and our series in the US.
BACKGROUND
Historically, surgical gastrostomies, gastrojejunostomy, and percutaneous endoscopic gastrostomy have been used palliatively. Recently, enteral stenting has also provided a means of reestablishing gastrointestinal flow in proximal and colonic obstructions.


METHODS
Seven patients with known intraabdominal malignancy leading to gastrointestinal obstruction were evaluated for PTEG. Ultrasonography, fluoroscopy, and a rupture-free balloon were used in placement. An endoscope was not used. Consent was obtained from all patients. The procedure was performed by a single surgical endoscopist in an endoscopy suite. Patients had appropriate hemodynamic monitoring with pulse oximetry, and they were given preprocedure antibiotics and sedation.


RESULTS
PTEG was successfully placed and alleviated symptoms in all seven patients. One complication occurred; in the fourth patient subcutaneous emphysema developed on postoperative day 1, and was managed nonoperatively. All patients were discharged from the hospital.


CONCLUSIONS
PTEG is a safe and effective technique for decompression in malignant gastrointestinal obstruction.
Mackey
Richard
R
Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Chand
Bipan
B
Oishi
Hideto
H
Kameoka
Shingo
S
Ponsky
Jeffrey L
JL
D000368:Aged; D019299:Decompression, Surgical / Q000295:instrumentation*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*