Introducer Percutaneous Endoscopic Gastrostomy in Palliative Care of Patients with Esophageal Cancer

In the treatment of esophageal cancer and palliative care, nutritional status plays an important role in the patients' tolerance of treatment, affects the quality of life, and outcomes. Alimentation in such patients can be achieved by enteral or parenteral nutrition but the enteral route is the preferring option. Pre-pyloric feeding is easier and may result in greater nutritional benefits than post-pyloric feeding. Gastrostomy is the conventional option for intra-gastric feeding, hydration, and drug administration. Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure and is currently the procedure of choice. Two PEG techniques are clinically used worldwide: pull and push or introducer method. The pull-type technique is the most commonly used method, but the concerning point is that the implantation of esophageal cancer cells into the gastrostomy stroma. The introducer method is a safe alternative and effective technique for enteral feeding to the stomach with the avoidance of cancer cells seeding.