Percutaneous transesophageal gastrostomy catheters: indication, technique, and outcome.

Learning Objectives: To review indications, technique, and outcomes from percutaneous transesophageal gastrostomy (PTEG) catheters. We review 12 successfully placed PTEG catheters at our institution over four years. Background: Patients unable to receive percutaneous fluoroscopic gastrostomy (PFG) catheters are at risk for developing long-term complications from indwelling nasogastric (NG) tubes. PTEG catheters are a feasible alternative offering palliative relief for patients needing either venting or feeding support. Clinical Findings/Procedure Details: Once adequate sedation is achieved, a guidewire is passed through an existing NG tube, which is subsequently removed. A 25 mm x 4 cm balloon catheter is then advanced into the stomach. The balloon is insufflated with contrast and withdrawn under fluoroscopy to just below the thoracic inlet. An appropriate access site is chosen on the lower left neck, and a 21-gauge needle is used to puncture the balloon under ultrasound guidance. A 0.018” microwire is passed through the needle and coiled in the balloon. The balloon and microwire are then passed, in tandem, into the gastric lumen and the balloon is disengaged from the microwire. The neck access is then sequentially dilated to accommodate a 14-French, 45-cm Mac Lock catheter (Cook, Bloomington, IN), which is passed into the stomach or jejunum and used for venting or feeding, as appropriate. In our experience, the most commonly encountered malignancy in need of an alternative gastrostomy approach has been metastatic gastric carcinoma (67%), ovarian carcinoma (17%), esophageal carcinoma (8%), and gallbladder carcinoma (8%). Patients survived 40.5 days (mean, range 28-85 days) following placement. Conclusion and/or Teaching Points: PTEG catheters are an essential tool for an interventional radiologist, providing patients an alternative for feeding or venting when direct percutaneous access into the stomach or jejunum is contraindicated. [Copyright &y& Elsevier]