Percutaneous Transesophageal Gastrostomy Tube for Decompression of Malignant Obstruction: Report of the First Case and Our Series in the US

Percutaneous transesophageal gastrostomy (PTEG): a safe and effective technique for gastrointestinal decompression in malignant obstruction and massive ascites

“…The inability to bring the gastric wall in apposition to the abdominal wall, having massive ascites and tumor invasion of the anterior gastric wall are absolute contraindications to standard PEG placement [15]. Prior gastric resection, hepatomegaly, and obesity are relative contraindications [2,8,15]. PTEG was developed in Japan as a treatment option for patients with contraindications to PEG and those in whom a PEG would be technically difficult to place [2,[6][7][8]10].…”

“…Prior gastric resection, hepatomegaly, and obesity are relative contraindications [2,8,15]. PTEG was developed in Japan as a treatment option for patients with contraindications to PEG and those in whom a PEG would be technically difficult to place [2,[6][7][8]10]. One major advantage that PTEG has over standard PEG is that it eliminates the possibility of peritonitis from gastric content leaking into the peritoneal cavity by avoiding direct access into the abdomen.…”

“…This may also be directly related to poor apposition of the gastric wall to the abdominal wall and suboptimal tract formation around the catheter secondary to malnutrition and ascites [14,16]. PTEG, just like an NG tube, also has the advantage of better stomach decompression compared to the PEG [2]. This is because the catheter lies in the most dependent portion of the stomach, being the posterior fundus and corpus.…”

“…All patients received preprocedural antibiotics, intravenous sedation, and local anesthetic. The procedures were done as previously described in 2005 by Mackey et al [2] and Oishi et al [8] in 2003. Briefly, the procedure is started by inserting a deflated rupture-free balloon (RFB) over a guide wire into the cervical esophagus through the nostril (Fig.…”

“…patients [2,4,8,10,11]. Percutaneous access is achieved in a nonsurgical and nonendoscopic manner through the cervical esophagus using ultrasound and fluoroscopy.…”