IDDF2019-ABS-0059 Percutaneous transesophageal gastro-tubing (PTEG) for long term gut access when endoscopic gastrostomy is unsuitable

Background Percutaneous endoscopic gastrostomy (PEG) is often considered the route of choice for long-term access to the gut. However, it may not be feasible in some patients, such as patients with a previous gastric resection or severe hiatal hernia. Percutaneous transesophageal gastro-tubing (PTEG) is a minimally invasive technique developed in Japan to access the gut via an esophagostomy. This technique is usually performed with the aid of ultrasonography under radiological guidance. PTEG can be used for either long term enteral nutrition or bowel decompression when PEG is contraindicated. Methods This observational study was conducted to evaluate our experience with PTEG. Twenty four patients (17 males and 7 females) who underwent the procedure at our hospital from 2012 to 2018 were included and analysed in this study. Results Average patient age was 81.8 (71 - 93) years. Indications for PTEG were previous gastric resection in 17 patients, left diaphragm disorder in 3 patients, interposing transverse colon between the abdominal wall and anterior gastric wall in 3 patients, and severe gastrostomy site leakage in one patient. Twenty-three patients underwent the procedure for enteral nutrition while one patient required palliative bowel decompression. Tube placement was successful in all patients. In 23 patients, PTEG was performed by approaching the left side of the neck. One patient required a right side approach. A specialized 15 Fr size tube (45 cm in length) was used during initial placement. The mean postoperative length of stay was 18.9 (6 - 48) days. Postoperative adverse events included accidental tube dislodgement in 3 patients, thyroid gland mispuncture in 2 patients, left inferior thyroid artery injury in one patient and tracheoesophageal fistula in one patient. There was no procedure-related mortality and only one patient died within 30 days after the procedure due to underlying comorbidities. Ten patients were discharged with some oral intake and 2 patients recovered full oral intake, enabling removal of the tube. Conclusions PTEG is feasible in patients requiring long term gut access but is not suitable candidates for PEG. It is a relatively safe procedure and should be offered as a more comfortable alternative to nasogastric tubing.