Percutaneous Transesophageal Gastrostomy

Gastrostomy tube placement is a well-established technique for providing long-term feeding or decompression to patients with dysphagia or the need for gastric venting. However, direct transabdominal access to the stomach is not feasible in some patients, such as those without a safe percutaneous route to the stomach, with conditions that may inhibit tract healing, and/or at high risk of peritonitis. For these patients, percutaneous transesophageal gastrostomy (PTEG) is a safe and effective technique for providing gastric access for enteral feeding or decompression. PTEG placement involves ultrasound-guided percutaneous access to the cervical esophagus using a fluid-filled balloon as a target. Since the peritoneum is not breached during PTEG placement, the risks of peritoneal spillage of enteric contents and intra-abdominal hemorrhage are avoided. However, placement requires a safe esophagostomy window and has contraindications and complications distinct from direct transabdominal access. Here, we describe the approach to patient workup and PTEG placement, present a few special situations that can be encountered, and discuss existing data regarding patient outcomes.