title: Percutaneous endoscopic gastrostomy as a tool to assist pneumatic dilation in a difficult case of sigmoid esophagus.
abstract: We describe a case of a long-standing, untreated achalasia with a huge sigmoid esophagus in a 58-year-old Caucasian man who declined surgery. All means of classical endoscopic approach for pneumatic dilation, including the use of an overtube, were impossible because any attempt to propel the balloon dilator made the guide wire pull back out of the stomach because of the large loops and the tortuosity of the esophagus. For this reason, we used, for the first time, a combined approach of percutaneous gastrostomy and endoscopy in order to fix the guide wire at two points, achieving a pneumatic dilation in this way. A few months later, a significant improvement in the symptoms and nutritional status of the patient were observed.
authors.affiliation: Gastroenterology Unit, Alexandra General Hospital, Greece.
authors.forename: Spyros
authors.initials: S
authors.lastname: Michopoulos
authors.forename: Georgios
authors.initials: G
authors.lastname: Stamatis
authors.forename: Stephanos
authors.initials: S
authors.lastname: Karagiannis
authors.forename: Fotis
authors.initials: F
authors.lastname: Dimopoulos
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Archavlis
authors.forename: Athanasios J
authors.initials: AJ
authors.lastname: Archimandritis
mesh_terms: D002404:Catheterization / Q000379:methods*; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004947:Esophagus / Q000000981:diagnostic imaging; D005773:Gastroscopy; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed