| [ Summary ] |
For enteral nutrition and / or decompression, percutaneous endoscopic gastrostomy (PEG) is a generally accepted technique world-wide, because PEG is a minimally invasive surgery, employing safe, simple and easy techniques. However, there are cases where it is difficult to perform PEG yet. For example, those with a post-gastrectomy status, massive ascites, etc. In these cases, PEG may not only be difficult but also a dangerous technique. If cases are difficult to perform PEG, there might be some alternative procedure. For example, naso gastric tubing (NGT), percutaneous trans-esophageal gastro-tubing(PTEG), percutaneous endoscopic jejunostomy (PEJ), usual gastrostomy using laparotomy, and others. NGT may be limited to short term use, because of the pain and terrible discomfort which may result. In PEJ procedure, an operator may not be able to find the best puncture site easily as is possible with PEG. In usual gastrostomy, using laparotomy, the procedure may be such an invasive technique as to require general anesthesia in serious cases. Basically, PTEG was invented in 1994 for cases where it is difficult to perform PEG. PTEG performed with a fluoroscope and ultrasonograms, is safe, simple and easy tubing method via cervical esophagostomy like a PEG. In this paper, we described the indications and best choices for each technique. |