Percutaneous transesophageal gastro-tubing (PTEG) as an alternative long-term tube feeding procedure when gastrostomy is not feasible

Abstract

Background:Percutaneous transesophageal gastro-tubing (PTEG) is a minimally invasive technique to access the gut via an esophagostomy. However, this procedure is not well known and the literature available is still fairly limited. This observational study was conducted to evaluate our experience using this method as an alternative long-term tube feeding procedure when gastrostomy is not suitable.Methods:A total of 15 patients (10 males and 5 females) who underwent PTEG at our institution from 2012 to 2016 were observed and analyzed in this study.Results:The average age was 80.1 (71–93) years. Underlying conditions that required PTEG were previous gastric resection in 11 patients, left diaphragm disorder in 2 patients, interposing transverse colon between the abdominal wall and anterior gastric wall in 1 patient, and severe gastrostomy site leakage in 1 patient. Tube placement was successful in all patients by approaching the left side of the neck, using a 15 Fr size tube. The mean postoperative length of stay was 22 (8–48) days. Postoperative adverse events included accidental tube dislodgement in three patients, tracheoesophageal fistula in one patient, inferior thyroid artery injury in one patient and thyroid gland mispuncture in one patient. There was no procedure-related mortality nor mortality at 30 days. Eight patients were discharged with some oral intake.Conclusions:PTEG is feasible in patients requiring long-term tube feeding for whom gastrostomy is unsuitable. It is an effective long-term tube feeding procedure and should be offered as a more comfortable alternative to nasogastric tubing.

Relationship of early acute complications and insertion site in push method percutaneous endoscopic gastrostomy

“…To avoid the unnecessary puncture of gastroepiploic blood vessels, selecting three gastropexy points in the pattern of an equilateral triangle instead of four points may also reduce complications www.nature.com/scientificreports/ www.nature.com/scientificreports/ during PEG tube insertion at the PW of the GC, especially for cases of esophageal hernia. In addition, direct percutaneous endoscopic jejunostomy 24 , percutaneous transesophageal gastro-tubing 25 , safe gastric puncture point by a plain abdominal film with air insufflation technique 26 , CT-guided PEG 27 , and laparoscopy-assisted introducer PEG 28,29 should be considered as alternative methods to achieve long-term enteral nutrition. It is important for clinicians to select from push and pull methods as flexibly as possible according to the patient's condition in order to reduce the risk of severe complications.…”

Management of malignancy-associated bowel obstruction by cervical esophagostomy and total parenteral nutrition, case series of 2 patients

“…Previous investigators have suggested that prolonged intestinal feeding or decompression through an esophagostomy tube is possible. Yoon and colleagues studied 15 patients who underwent this procedure over a four year time period [ 8 ]. Their most common adverse event was accidental tube dislodgement.…”

“…The tube is anchored at the neck. Alternatively, as described by Toh Yoon and Nishihara, the tube can be inserted under ultrasonographic guidance with the use of a rupture-free balloon [ 8 ].…”

Percutaneous Transesophageal Gastro‐Tubing as an Alternative Procedure of Levodopa Administration in Parkinson's Disease

“…Although the procedures of PTEG are less invasive than those of PEG, PTEG remains unknown to most surgeons and gastroenterologists outside of Japan. 4 PEG is commonly used for long-term tube feeding to address dysphagia in patients with advanced PD who experience swallowing problems as the disease progresses. However, PEG is not suitable in some cases, such as gastrectomy, severe ascites, advanced gastric cancer, and interposing organs between the anterior gastric wall and abdominal wall.…”

“…However, PEG is not suitable in some cases, such as gastrectomy, severe ascites, advanced gastric cancer, and interposing organs between the anterior gastric wall and abdominal wall. 4 Moreover, a large hiatal hernia can lead to unsuccessful PEG tube placement. 5 Specifically, our patient could not undergo PEG because the large sliding hiatal hernia hindered the identification of a safe puncture site.…”