Tags

Type your tag names separated by a space and hit enter

Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intra-abdominal metastasis.
Gastrointest Endosc. 2010 Feb; 71(2):402-6.GE

Abstract

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.

PATIENTS

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.

Authors+Show Affiliations

Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20152318

Citation

Singal, Ashwani Kumar, et al. "Percutaneous Transesophageal Gastrostomy Tube Placement: an Alternative to Percutaneous Endoscopic Gastrostomy in Patients With Intra-abdominal Metastasis." Gastrointestinal Endoscopy, vol. 71, no. 2, 2010, pp. 402-6.
Singal AK, Dekovich AA, Tam AL, et al. Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intra-abdominal metastasis. Gastrointest Endosc. 2010;71(2):402-6.
Singal, A. K., Dekovich, A. A., Tam, A. L., & Wallace, M. J. (2010). Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intra-abdominal metastasis. Gastrointestinal Endoscopy, 71(2), 402-6. https://doi.org/10.1016/j.gie.2009.10.037
Singal AK, et al. Percutaneous Transesophageal Gastrostomy Tube Placement: an Alternative to Percutaneous Endoscopic Gastrostomy in Patients With Intra-abdominal Metastasis. Gastrointest Endosc. 2010;71(2):402-6. PubMed PMID: 20152318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intra-abdominal metastasis. AU - Singal,Ashwani Kumar, AU - Dekovich,Alexander A, AU - Tam,Alda L, AU - Wallace,Michael J, PY - 2009/06/11/received PY - 2009/10/20/accepted PY - 2010/2/16/entrez PY - 2010/2/16/pubmed PY - 2010/5/21/medline SP - 402 EP - 6 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 71 IS - 2 N2 - 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. PATIENTS: 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. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/20152318/Percutaneous_transesophageal_gastrostomy_tube_placement:_an_alternative_to_percutaneous_endoscopic_gastrostomy_in_patients_with_intra_abdominal_metastasis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(09)02691-1 DB - PRIME DP - Unbound Medicine ER -