title: A 3-step gradual dilation method: a new safe technique of percutaneous endoscopic gastrostomy for obstructive esophageal cancer.
abstract: Although percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide enteral nutrition for a longer time period, in obstructive esophageal cancer, we cannot safely perform endoscopic access to the stomach even with the ultrathin endoscope. We experienced 1 fatal case due to esophageal perforation caused by balloon dilation, and hence, we developed a safer method. We treated 4 patients with obstructive esophageal cancer using a 3-step gradual dilation method with nasogastric tubes (from 8 to 16 Fr). After about 2 weeks of initial dilation, we could safely perform endoscopic access to the stomach with the ultrathin endoscope and PEG placement using the introducer technique. The 3-step gradual dilation method is a safe and easy procedure for endoscopic access to the stomach. It can be used to provide enteral access as a palliative treatment for patients with obstructive esophageal cancer that is not suitable for conventional PEG placement.
authors: Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Nobuyoshi
authors: N
authors: Takeshita
authors: Masaya
authors: M
authors: Uesato
authors: Kiyohiko
authors: K
authors: Shuto
authors: Toru
authors: T
authors: Shiratori
authors: Tsuguaki
authors: T
authors: Kono
authors: Yasunori
authors: Y
authors: Akutsu
authors: Isamu
authors: I
authors: Hoshino
authors: Daisuke
authors: D
authors: Horibe
authors: Kazuo
authors: K
authors: Narushima
authors: Shunsuke
authors: S
authors: Imanishi
authors: Tetsuro
authors: T
authors: Maruyama
authors: Yoshihide
authors: Y
authors: Semba
authors: Takeshi
authors: T
authors: Toyozumi
authors: Hisahiro
authors: H
authors: Matsubara
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis; D004106:Dilatation / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000175:diagnosis; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation; D008297:Male; D016896:Treatment Outcome