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.

A case of sigmoid-type achalasia treated with hand-assisted laparoscopic Heller-Dor procedure

“…The application of HALS broadened the area of exposure of the lower esophagus as compared to that via a laparoscope, thus allowing steady straightening and fi xing of the lower esophagus. One report recommends a gastropexy via a percutaneous endoscopic gastrostomy to prevent a re-prolapse of the lower esophagus into the mediastinum [18]; this, however, was not performed in our case.…”