| Theme |
The Present State of Percutaneous Endoscopic Gastrostomy (PEG) |
| Title |
Percutaneous Trans-esophageal Gastro-tubing (PTEG) |
| Author |
Hideto Oishi |
Division of Gastroenterological Surgery, Department of Surgery, Yachiyo Medical Center, Tokyo Womenʼs Medical University |
| Author |
Atsushi Mitsunaga |
Department of Endoscopy, Yachiyo Medical Center, Tokyo Womenʼs Medical University |
| [ Summary ] |
PTEG (percutaneous trans-esophageal gastro-tubing) was introduced in 1994 for cases where there was difficulty performing PEG (percutaneous endoscopic gastrostomy). Most PEG contraindications can be accepted as PTEG related conditions. These include postgastrectomy status and massive ascites. PTEG is usually used for enteral nutrition and/or gastrointestinal decompression, and is considered to be as useful as PEG. PTEG is a non-vascular interventional radiological technique using a rupture-free balloons (RFB). There are two standard procedures for performing PTEG. One is esophagostomy under ultrasonographic control and the other is tube placement under fluoroscopic control. RFB was invented in 1994 to ameliorate difficulties with PTEG procedures. The esophagus is a hollow organ, with its cavity usually kept empty except for swallowing. Therefore, it is not easy to puncture the esophageal cavity when inserting a guide wire into the cavity. RFB has two effective functions when performed under ultrasonographic control. It has helped to solve previous problems. One solution is that by inserting an inflated RFB in the cervical esophagus can keep the esophageal cavity open for puncturing procedures under ultrasonic control. The other is that an inflated RFB can easily make a puncturing route, because, by compressing cervical organs between the RFB and ultrasound transducers, cervical organs can be moved from the front of the esophagus. In this chapter, indications for PTEG involving standard procedures are described. |