Related Experiment Video
Updated: Dec 29, 2025

Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
Published on: August 22, 2025
Percutaneous endoscopic gastrostomy through a cervical esophageal fistula. An alternative, much improved technique
George Stavrou1, Vassilios Grosomanidis2, Anastasia Sarafidou3
1Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece; Department of Colorectal Surgery, Addenbrooke's Hospital, Hills Road, CB22QQ Cambridge, UK.
Purpose:
Percutaneous endoscopic gastrostomy [PEG] by the pull-technique is easy and safe to perform through the oral cavity. However, the presence of a cervical esophageal fistula, either due to tumor invasion or simply inflammation and tissue necrosis after previous intervention or radiotherapy, in the anterior cervical region is of crucial importance when passing the endoscope and the PEG catheter from the mouth downwards.
Methods:
We describe a modification of the standard peroral PEG, which is to insert the endoscope from the cervical esophageal opening instead of the oral cavity, and we support the use of this "stoma" as a way to protect it and avoid possible forceful dilatation/expansion when advancing the endoscope and the gastrostomy catheter through the mouth.
Results:
The performance of PEG through the cervical esophageal opening was applied in 8 cases of esophageal fistula of different primary etiology but where the oro-pharyngeal passage was easily accessible. The procedure was technically successful in all patients, and no bleeding or tearing of the friable esophageal wall was evident.
Conclusion:
The use of the esophageal fistula at the anterior cervical region as a route for PEG insertion is a safe and practical alternative, highly to be recommended.
More Related Videos
09:40An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
07:44Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Related Concept Videos
Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
Endoscopic Procedures V: ERCP
Patient...
Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques