Percutaneous transesophageal gastrostomy tube for decompression of malignant obstruction: report of the first case and our series in the US.

BACKGROUND: Historically, surgical gastrostomies, gastrojejunostomy, and percutaneous endoscopic gastrostomy have been used palliatively. Recently, enteral stenting has also provided a means of reestablishing gastrointestinal flow in proximal and colonic obstructions.

STUDY DESIGN: Seven patients with known intraabdominal malignancy leading to gastrointestinal obstruction were evaluated for PTEG. Ultrasonography, fluoroscopy, and a rupture-free balloon were used in placement. An endoscope was not used. Consent was obtained from all patients. The procedure was performed by a single surgical endoscopist in an endoscopy suite. Patients had appropriate hemodynamic monitoring with pulse oximetry, and they were given preprocedure antibiotics and sedation.

RESULTS: PTEG was successfully placed and alleviated symptoms in all seven patients. One complication occurred; in the fourth patient subcutaneous emphysema developed on postoperative day 1, and was managed nonoperatively. All patients were discharged from the hospital.

CONCLUSIONS: PTEG is a safe and effective technique for decompression in malignant gastrointestinal obstruction.