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Gradual tube dilation method before percutaneous endoscopic gastrostomy for obstructive esophageal cancer

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Abstract

Objectives

In patients with obstructive esophageal cancer (OEC) with stenosis of the tract to the stomach, the percutaneous endoscopic gastrostomy (PEG) procedure cannot be performed if the endoscope is unable to pass through to the stomach. Our aim was to describe the safety and utility of the gradual tube dilation method (GTD) before PEG in cases of OEC.

Methods

This study enrolled 38 consecutive patients. If an ultrathin transnasal endoscope (UTNE) could successfully reach the stomach through the esophageal stenosis, then PEG was performed without using the GTD. If even the UTNE could not be passed to the stomach, PEG was performed after the GTD. The GTD shows the method that gradually increases the size from an 8 Fr to 16 Fr nasogastric tube which passed through the obstruction before performing PEG. We conducted a retrospective review of all patients who received the GTD. The complications were examined from the first UTNE to the completion of PEG.

Results

Seventeen of 38 patients received the GTD. All 17 patients successfully underwent the PEG procedures. The intubation period was 9.8 ± 3.4 days. The mean number of replacements was 2.5. Regarding complications, only three of the 17 patients experienced a sore throat. No significant differences were found in the PEG procedure times between the patients with the GTD and those without the GTD (P = 0.360).

Conclusions

If patients with progressive esophageal cancer, such as OEC, need to undergo PEG, then the GTD is considered to be a useful modality for dilating the stenosis simply and safely.

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Abbreviations

PEG:

Percutaneous endoscopic gastrostomy

UTNE:

Ultrathin transnasal endoscope

OEC:

Obstructive esophageal cancer

GTD:

Gradual tube dilation method

References

  1. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15:872–5.

    Article  PubMed  CAS  Google Scholar 

  2. Gauderer MW. Percutaneous endoscopic gastrostomy-20 years later: a historical perspective. J Pediatr Surg. 2001;36:217–9.

    Article  PubMed  CAS  Google Scholar 

  3. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 2014;20:7739–51.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schneider AS, Schettler A, Markowski A, Luettig B, Kaufmann B, Klamt S, et al. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol. 2014;49:891–8.

    Article  PubMed  Google Scholar 

  5. Ogino H, Akiho H. Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer. World J Gastrointest Pathophysiol. 2013;4:119–25.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sako A, Yasunaga H, Horiguchi H, Fushimi K, Yanai H, Uemura N. Prevalence and in-hospital mortality of gastrostomy and jejunostomy in Japan: a retrospective study with a national administrative database. Gastrointest Endosc. 2014;80:88–96.

    Article  PubMed  Google Scholar 

  7. Lee HS, Lim CH, Park EY, Lee WH, No JH, Jun BY, et al. Usefulness of the introducer method for percutaneous endoscopic gastrostomy using ultrathin transnasal endoscopy. Surg Endosc. 2014;28:603–6.

    Article  PubMed  Google Scholar 

  8. Croshaw RL, Nottingham JM. Laparoscopic-assisted percutaneous endoscopic gastrostomy: its role in providing enteric access when percutaneous endoscopic gastrostomy is not possible. Am Surg. 2006;72:1222–4.

    PubMed  Google Scholar 

  9. Ho HS, Ngo H. Gastrostomy for enteral access. A comparison among placement by laparotomy, laparoscopy, and endoscopy. Surg Endosc. 1999;13:991–4.

    Article  PubMed  CAS  Google Scholar 

  10. Takeshita N, Uesato M, Shuto K, Shiratori T, Kono T, Akutsu Y, et al. A 3-step gradual dilation method: a new safe technique of percutaneous endoscopic gastrostomy for obstructive esophageal cancer. Surg Laparosc Endosc Percutan Tech. 2014;24:140–2.

    Article  Google Scholar 

  11. Takahashi T, Miyano G, Shiyanagi S, Lane GJ, Yamataka A. Laparoscopy-assisted percutaneous endoscopic gastrostomy using a “Funada-kit II” device. Pediatr Surg Int. 2012;28:925–9.

    Article  PubMed  Google Scholar 

  12. Japan Esophageal Society. Japanese classification of esophageal cancer, tenth edition: part I. Esophagus. 2009;6:1–25.

    Article  Google Scholar 

  13. Ruggeri E, Agostini F, Fettucciari L, Giannantonio M, Pironi L, Pannuti F. Home artificial nutrition in advanced cancer patients. Tumori. 2013;99:218–24.

    PubMed  Google Scholar 

  14. Yuki M, Amano Y, Komazawa Y, Fukuhara H, Shizuku T, Yamamoto S, et al. Unsedated transnasal small-caliber esophagogastroduodenoscopy in elderly and bedridden patients. World J Gastroenterol. 2009;15:5586–91.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Therasse E, Oliva V, Lafontaine E, Perreault P, Giroux MF, Soulez G. Balloon dilation and stent placement for esophageal lesions: indications, methods, and results. Radiographics. 2003;23:89–105.

    Article  PubMed  Google Scholar 

  16. Standards of Practice Committee, Egan JV, Baron TH, Adler DG, Davila R, Faigel DO, Gan SL, et al. Esophageal dilation. Gastrointest Endosc. 2006;63:755–60.

    Article  Google Scholar 

  17. Fan Y, Song HY, Kim JH, Park JH, Kim J, Jung HY, Kim SB, Lee H. Evaluation of the incidence of esophageal complications associated with balloon dilation and their management in patients with malignant esophageal strictures. AJR Am J Roentgenol. 2012;198:213–8.

    Article  PubMed  Google Scholar 

  18. Sabbagh C, Browet F, Diouf M, Cosse C, Brehant O, Bartoli E, et al. Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg. 2013;258:107–15.

    Article  PubMed  Google Scholar 

  19. Margolis M, Alexander P, Trachiotis GD, Gharagozloo F, Lipman T. Percutaneous endoscopic gastrostomy before multimodality therapy in patients with esophageal cancer. Ann Thorac Surg. 2003;76:1694–1697 (discussion 1697–1698).

  20. Aiko S, Yoshizumi Y, Ishizuka T, Horio T, Sakano T, Kumano I, et al. Enteral immuno-enhanced diets with arginine are safe and beneficial for patients early after esophageal cancer surgery. Dis Esophagus. 2008;21:619–27.

    Article  PubMed  Google Scholar 

  21. Paccagnella A, Morassutti I, Rosti G. Nutritional intervention for improving treatment tolerance in cancer patients. Curr Opin Oncol. 2011;23:322–30.

    Article  PubMed  CAS  Google Scholar 

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Ethical Statement

This study conforms to the guidelines set forth in the Declaration of Helsinki revised in 2000. We have protected the privacy of the patient, and the manuscript does not include any identifying information. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of interest

The authors declare no conflicts of interests in association with this article.

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Authors and Affiliations

  1. Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan

    Masaya Uesato, Kiyohiko Shuto, Tsuguaki Kono, Yasunori Akutsu, Isamu Hoshino, Kentarou Murakami, Takumi Ohta, Tooru Shiratori & Hisahiro Matsubara

  2. Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan

    Kiyohiko Shuto

Authors
  1. Masaya Uesato
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  2. Kiyohiko Shuto
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  3. Tsuguaki Kono
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  4. Yasunori Akutsu
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  5. Isamu Hoshino
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  6. Kentarou Murakami
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  7. Takumi Ohta
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  8. Tooru Shiratori
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  9. Hisahiro Matsubara
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Corresponding author

Correspondence to Masaya Uesato.

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Uesato, M., Shuto, K., Kono, T. et al. Gradual tube dilation method before percutaneous endoscopic gastrostomy for obstructive esophageal cancer. Esophagus 13, 68–73 (2016). https://doi.org/10.1007/s10388-015-0500-x

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  • DOI: https://doi.org/10.1007/s10388-015-0500-x

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