Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intra-abdominal metastasis.
BACKGROUND
PEG/jejunostomy (PEG/J) is often placed in patients with metastatic gastric cancer for palliating bowel obstruction or for feeding. However, PEG/J placement may not always be possible for many reasons.


OBJECTIVE
We wish to bring attention to the percutaneous transesophageal gastrostomy/jejunostomy (PTEG/J) as a viable alternative to nasogastric decompression in patients who are not candidates for PEG/J. PTEG/J is a largely unknown technique in the United States that designed to gain access to the stomach and proximal small bowel in these patients. We describe the use of PTEG/J in 3 patients with metastatic gastric cancer by using resources and techniques readily available in a well-stocked interventional radiology suite.


METHODS
In the first case, percutaneous transesophageal gastrostomy (PTEG) was placed for palliation of intractable nausea and vomiting in a 37-year-woman with diffuse gastric cancer and peritoneal carcinomatosis. In the second case, PTEG was extended into the jejunum for feeding a 60-year-old woman with metastatic gastric cancer. In the third case, PTEG extending into the jejunum was placed in a 69-year-old man for palliation of bowel obstruction caused by metastatic gastric cancer and peritoneal carcinomatosis.


METHODS
After adequate sedation is administered, a 22 x 4-mm balloon catheter is passed into the esophagus over a guidewire just below the thoracic inlet. The balloon is ruptured with a needle passed through the neck under US guidance. A guidewire is then passed through the needle into the balloon and carried into the stomach or proximal small bowel by advancing the balloon catheter. The track is then dilated over the guidewire and a pigtail 45-cm-long 14F nephrostomy tube then passed into the stomach or into the proximal small bowel over the guidewire. The catheter is secured by suturing to the skin of the neck.


RESULTS
PTEG/J was effective in achieving palliation or feeding in our patients. No complications occurred.


CONCLUSIONS
PTEG/J is a safe and effective alternative to standard percutaneous gastrostomy/jejunostomy tube placement for decompression of bowel obstruction or feeding in appropriately selected patients.
Singal
Ashwani Kumar
AK
Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Dekovich
Alexander A
AA
Tam
Alda L
AL
Wallace
Michael J
MJ
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods; D004750:Enteral Nutrition / Q000379:methods; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005773:Gastroscopy; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary*; D011788:Quality of Life; D018570:Risk Assessment; D012494:Sampling Studies; D013274:Stomach Neoplasms / Q000150:complications; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler