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

Abstract

Enteral feeding and gastric decompression devices are common in critical, terminal, and chronically ill patients. Percutaneous transesophageal gastrostomy (PTEG) is a nonsurgical technique that creates an esophagostomy and allows enteral access in patients with a hostile abdomen, altered gastric anatomy, massive ascites, and carcinomatosis. We review our indications, technical experience, complications, and short- and long-term quality of life (QOL) in patients that underwent the PTEG procedure. Patients were terminally ill from advanced cancer requiring gastrointestinal decompression or had hostile abdomens needing long-term feeding access. The procedure is carried out by inserting a rupture-free balloon (RFB) into the cervical esophagus and utilizing transcutaneous ultrasound to puncture the balloon. A guide wire is passed through the needle into the balloon, followed by a dilator and sheath. The in-dwelling catheter is inserted through the sheath, which exits the esophagus, and resides in the stomach. Proper placement is confirmed by fluoroscopy. From December 2003 to January 2006, 17 patients were treated with PTEG. Except for two patients, all of the patients had advanced metastatic cancer. Presenting symptoms were nausea, vomiting, and dysphagia. Average age was 62.8 years, with nine men. Placement was successful in 16 patients (94%). There were no major complications and three minor complications (17.6%). Minor complications included two esophageal leaks at the catheter site and one catheter dislodgement. Seven patients (41.2%) died within 1 month after the procedure from their preexisting medical conditions. All patients were capable of being discharged from the hospital with adequate enteral access and gastrointestinal decompression. PTEG is a safe and effective method of enteral feeding and decompression in patients that have contraindications to standard enteral access. Appropriate patient selection and timing of PTEG placement is crucial for optimum benefit.