Percutaneous Transesophageal Gastrostomy Research Articles

Enteric Access: IR Perspective

AbstractGastrostomy tube placement may be needed for nutritional support, as in the setting of neurogenic dysphagia or head and neck malignancy, or for gastric decompression, as in the setting of malignant small bowel obstruction. Additionally, gastrojejunostomy or direct jejunostomy tubes may be needed in the setting of gastric outlet obstruction among other indications. Surgical, endoscopic, and percutaneous approaches are all well-described with generally similar outcomes. In this article, the standard radiologic percutaneous gastrostomy technique is reviewed including both the “push” and “pull” methods. Then, the special indications and techniques of advanced percutaneous enteral access such as percutaneous transesophageal gastrostomy and direct jejunostomy are discussed with examples shown.

Review of Percutaneous Transesophageal Gastrostomy: A Multi-Hospital Academic Institution's Case Series of 24 Patients

Review of Percutaneous Transesophageal Gastrostomy: A Multi-Hospital Academic Institution's Case Series of 24 Patients

Percutaneous Transesophageal Gastrostomy: Procedural Technique and Outcomes

PurposeTo demonstrate the safety and effectiveness of percutaneous transesophageal gastrostomy (PTEG) as a palliative option in patients with malignant bowel obstructions (MBOs), and provide a comprehensive review of PTEG indications, placement technique, and short- and long-term outcomes. Materials and MethodsThirty-eight consecutive patients who underwent a PTEG procedure attempt from 2014 to 2022 were included in this analysis. Clinical indications, method of placement, technical and clinical success, adverse events, including procedure-related mortality, and effectiveness were assessed. Technical success was defined as placement of a PTEG. Clinical success was defined as improvement in clinical symptoms following PTEG placement. ResultsOf the 38 patients who underwent PTEG, 19 (50%) were men and 19 (50%) were women (median age, 58 years; range, 21–75 years). Three (8%) PTEG placements were performed with the patients under moderate sedation, whereas the remainder (92%) were performed with the patients under general anesthesia. Technical success was achieved in 35 of the 38 (92%) patients. The mean catheter duration was 61 days (median, 29 days; range, 1–562 days), with 5 of the 35 patients requiring tube exchanges after initial placement. Moreover, 7 of the 35 patients with successful PTEG placement experienced an adverse event, including 1 case of non–procedure-related mortality. All patients with successful PTEG placement experienced improvement in clinical symptoms. ConclusionsPTEG is an effective and safe option for patients with contraindications to traditional percutaneous gastrostomy tube placement in the setting of MBO. PTEG is an effective means of providing palliation and improving the quality of life.

Percutaneous Transesophageal Gastrostomy—A Compassionate Intervention for Malignant Bowel Obstruction in Patients Approaching End of Life (CS346)

Percutaneous Transesophageal Gastrostomy—A Compassionate Intervention for Malignant Bowel Obstruction in Patients Approaching End of Life (CS346)

A G-Tube Placed in the Side of Neck: Percutaneous Transesophageal Gastrostomy (PTEG) for Palliation of Malignant Bowel Obstruction (Sci201)

A G-Tube Placed in the Side of Neck: Percutaneous Transesophageal Gastrostomy (PTEG) for Palliation of Malignant Bowel Obstruction (Sci201)

Abstract No. 174 Relief When it Matters Most: Decompressive Percutaneous Transesophageal Gastrostomy for Long-term Management of Malignant Bowel Obstruction

Abstract No. 174 Relief When it Matters Most: Decompressive Percutaneous Transesophageal Gastrostomy for Long-term Management of Malignant Bowel Obstruction

Abstract No. 375 Percutaneous transesophageal gastrostomy (PTEG): a multiinstitutional review and largest reported case series in the United States

PTEG is an option for patients with malignant bowel obstruction (MBO). To date, only small case series of PTEG have been published in the U.S. We aim to provide data via a multiinstitutional review of PTEG indications, placement, and outcomes in what is the largest reported case series in the U.S.

What to do When Decompressive Gastrostomies and Jejunostomies are not Options? A Scoping Review of Transesophageal Gastrostomy Tubes for Advanced Malignancies

In advanced malignant bowel obstruction, decompressive gastrostomy tubes (GTs) may not be feasible due to ascites, peritoneal carcinomatosis, and altered gastric anatomy. Whereas nasogastric tubes (NGTs) allow temporary decompression, percutaneous transesophageal gastrostomy tubes (PTEGs) are an alternative method for long-term palliative decompression. This study performed a scoping review to determine outcomes with PTEG in advanced malignancies. A systematic literature search was performed to include all studies that reported the clinical results of PTEGs for malignancy. No language, national, or publication status restrictions were used. The analysis included 14 relevant studies with a total of 340 patients. In 11 studies, standard PTEGs were inserted with a rupture-free balloon's placement into the mouth or nose and esophageal puncture under fluoroscopy or ultrasound, followed by a guidewire into the stomach with placement of a single-lumen tube. Of 340 patients, 65 (19.1%) had minor complications, and 5 (2.1%) had significant complications, including bleeding and severe aspiration pneumonia. Of 171 patients, 169 with PTEGs (98.8%) reported relief of nasal discomfort from NGT and alleviation of obstructive symptoms. The one randomized controlled trial reported a significantly higher quality of life with PTEGs than with NGTs. When decompression for advanced malignancy is technically not feasible with a gastrostomy tube, the PTEG is a viable, safe option for palliation. The PTEG is associated with lower significant complication rates than the gastrostomy tube and significantly higher patient-derived outcomes than the NGT.

Abstract No. 596 Percutaneous transesophageal gastrostomy (PTEG): largest United States single-institution experience

Abstract No. 596 Percutaneous transesophageal gastrostomy (PTEG): largest United States single-institution experience

Percutaneous Transesophageal Access for Enteral Feeding Tube Placement.

The purpose of this study was to describe our experience with percutaneous transesophageal enteral feeding tube placement when percutaneous gastrostomy tube placement is not feasible. A retrospective review was performed from July 2018 to March 2019. Thirteen patients (9 females, 4 males), (age range 22-80years; mean age, 55years; mean body mass index of 24.6) underwent placement of 14 percutaneous transesophageal enteral feeding tubes. Relative contraindications to standard gastrostomy tube placement included: prior gastric surgery (5 patients), severe contractures/large body habitus (2), abdominal mesh (1), high riding stomach (1), interposition of bowel (1), ascites (1), and refractory gastrostomy tract leak (1). Patients were evaluated for functionality of the tube, complications, and patients' satisfaction with physical examination at 24h, review of electronic medical record and phone interviews at 1month, and 3-month follow-up. Complications were classified according to the CIRSE guidelines. Technical success rate was 100% with placement of seven percutaneous transesophageal gastrostomy tubes and seven percutaneous transesophageal jejunostomy tubes. One patient underwent tube placement twice after dislodgement. At 3-month follow-up, two patients had died, one patient was lost to follow-up, and 11 patients had properly working tubes. No major complications occurred. Minor complication rate was 43% (6/14). Patient's satisfaction scores ranged from "poor" 2/11 (18%) or "neutral" 4/11 (36.4%) to "satisfied/very satisfied" 5/11 (45.3%). Percutaneous transesophageal enteral feeding tube placement is feasible with a low complication rate. A majority of patients were either satisfied or neutral with the transesophageal enteral tube.

Percutaneous Transesophageal Gastrostomy (PTEG): A Safe and Well-Tolerated Procedure for Palliation of End-Stage Malignant Bowel Obstruction

ContextMalignant bowel obstruction (MBO) is a frequent complication in patients with advanced cancer. Symptom management for patients with end-stage MBO can be challenging, especially when venting gastrostomy is contraindicated. Percutaneous transesophageal gastrostomy (PTEG) is an alternative option allowing safe and effective symptom management in palliative care patients. ObjectivesWe describe our experience with an initial series of 10 patients with MBOs refractory to medical management who received PTEG for gastrointestinal decompression, with a focus on palliative outcomes and safety. MethodsWe retrospectively reviewed the charts of 10 patients with advanced malignancy and associated gastrointestinal obstruction who received PTEG for symptom management between March 2018 and November 2018. We report on patient diagnosis, indications for PTEG, outcomes after insertion, and any associated morbidity and mortality. ResultsPTEGs were successfully inserted in all 10 patients with contraindications to a venting gastrostomy. There were no acute postprocedural complications. Median time from PTEG insertion to death was 15 days. Symptoms of MBO improved in all 10 patients, and all were able to resume some degree of oral intake. Importantly, unlike with venting gastrostomies, all patients required suction to maintain resolution of MBO symptoms. ConclusionPTEG should be considered for gastrointestinal decompression in patients with MBO who are not candidates for surgical decompression or standard venting gastrostomy. This safe and effective procedure improves symptom management and quality of life for patients with MBO who are approaching end of life.

Percutaneous Transesophageal Gastrostomy (PTEG) as an Alternative When PEG Is Contraindicated

Percutaneous Transesophageal Gastrostomy (PTEG) as an Alternative When PEG Is Contraindicated

Abstract No. 227 - Percutaneous transesophageal gastrostomy (PTEG): indications, technique, and outcomes

PTEG technique is a rare palliative procedure performed in patients with a contraindication to percutaneous gastrostomy.We sought to evaluate our experience at a tertiary care center in 14 patients. This IRB approved, HIPAA-compliant study involved a search of the department’s electronic database to identify all PTEG procedures from 2014-2016.Electronic medical records were used to identify demographics, clinical history, cross-sectional imaging and outcomes for each patient.All available CT, US and procedural fluoroscopy images were reviewed to evaluate variations in technique.Procedures were performed under general anesthesia for airway protection;a 20 mm angioplasty balloon was used as a target for percutaneous access of the esophagus for placement of a 45cm,14F multipurpose drain. Between 2014-2016, PTEG was attempted in 14 patients (7M,7F) with an average age of 53(range 27-72) for gastric venting from malignant bowel obstruction.Average ECOG scores were 2 (range 1-4).Patients had metastatic disease originating from the ovary (28.7%), stomach (28.7%), pancreas (7.1%), liver (7.1%), colon (7.1%), appendix (7.1%), small bowel (7.1%), and lung (7.1%).The most common indication was peritoneal carcinomatosis (57.2%) followed by ascites (35.7%) and invasive gastric cancer (7.1%).Technical success of PTEG was 93% (n = 13).In 1 patient, fibrotic changes due to radiation therapy precluded access to the esophagus.Intraprocedural complication included aspiration during esophageal balloon inflation (n = 2; 15.4%).Immediate post-PTEG symptoms included throat pain (n = 5; 36%) which was resolved with oral viscous lidocaine.Long-term complications (n = 3; 21%)included occlusion of the PTEG (n = 1), aspiration (n = 1) and PTEG site cutaneous infection (n = 1).There was 1 death resulting from aspiration pneumonitis.No association between ECOG score and major/minor complications (p>0.05).Using the Edmonton Symptom Assessment Scale (ESAS)and the Karnofsky Performance Scale, patency rates and relief of obstructive symptoms were 100% at 7 and 14 days post-procedure (p<0.05). PTEG can provide dramatic symptomatic relief to palliative patients; ESAS and KPS scores were 100% up to 14 days post-placement.

Abstract No. 314 - Percutaneous transesophageal gastrostomy catheters: indication, technique, and outcome

Abstract No. 314 - Percutaneous transesophageal gastrostomy catheters: indication, technique, and outcome

Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intra-abdominal metastasis

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. 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. 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. 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. PTEG/J was effective in achieving palliation or feeding in our patients. No complications occurred. 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.

経皮経食道胃管挿入術(PTEG)後の自己抜去防止策としてのチューブ皮下トンネル埋没の試み

経皮経食道胃管挿入術(PTEG)後の自己抜去防止策としてのチューブ皮下トンネル埋没の試み

Percutaneous Transesophageal Gastrostomy (PTEG) is a More Acceptable Technique than Cervical Pharyngostomy

Heart, Lung and Esophageal Surgery Institute; University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania; E-mail: [email protected]

Percutaneous Transesophageal Gastrostomy (PTEG) is a More Acceptable Technique than Cervical Pharyngostomy

Ishizuka, Mitsuru MD; Nagata, Hitoshi MD; Takagi, Kazutoshi MD; Kubota, Keiichi MD Author Information

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

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.

Percutaneous Transesophageal Gastrostomy (PTEG) Placement in an Infant

Percutaneous Transesophageal Gastrostomy (PTEG) Placement in an Infant