A New Endoscopic Interventional Technique for the Percutaneous Trans-Esophageal Gastro-Tubing (PTEG)

Hideto Oishi, MD PhD, Noriyasu Shirotani, MD PhD, Shingo Kameoka, MD PhD. Division of Digestive and General Surgery, Department of Surgery, Yachiyo Medical Center, Tokyo Women’s Medical University

Background: In 1994, we invented Percutaneous Trans-esophageal Gastro-tubing (PTEG) for the patients who difficult to perform Percutaneous Endoscopic Gastrostomy (PEG). We already performed 176 cases of PTEG, and in Japan, more than 10,000 cases were done. Standard PTEG uses our original rupture-free balloon (RFB) and ultrasonographic and fluoroscopic interventions are required. So that, for safer, simpler and easier PTEG, we started to use endoscopic technique from 2003. To perform endoscopy assisted PTEG (EA-PTEG), we developed double balloon equiped overtube type RFB (DBOt-RFB).

Materials and methods: We performed 40 cases of EA-PTEG from April 2005 to May 2010. DBOt-RFB was made of vinyl chloride. It has double RFB covered window at a tip for the puncture. First, insert DBOt-RFB into esophagus under endoscopic control and inflate RFB with distilled water. Push patient’s cervical surface by penlight and adjust the position of DBOt-RFB window according to transmitted light. Then, puncture RFB by needle from patient’s neck under ultrasonographic control. Insert a guidewire through the needle into RFB lumen and secure it at skin level. Push DBOt-RFB into the distal lumen to release the guidewire from RFB. Withdraw DBOt-RFB and leave guidewire alone in the esophagus. Dilate the puncture site with a dilator and insert PTEG tube. Finally, adequately place the tube into gastrointestinal tract under endoscopic control.

Results: In all cases, EA-PTEG could be created approximately in 20 minutes. There were no major complications and therapeutic results were as good as standard PTEG and PEG. No fluoroscopic intervention was required.

Conclusions: EA-PTEG using DBOt-RFB is feasible and safer than standard PTEG. Since it doesn’t require the fluoroscope, EA-PTEG can be done at the bedside or endoscopic suite. We consider that EA-PTEG becomes another therapeutic option for the patients who need PEG.

Keywords: endoscope assisted percutaneous trans-esophageal gastro-tubing (EA-PTEG), interventional GI endoscopic techniques, esophagostomy, parenteral nutrition, gastrointestinal decompression