782 - Percutaneous Transesophageal Gastrostomy Tube Placement: A Primer for the Interventional Radiologist

Learning Objectives: This educational review will help providers become more confident with percutaneous transesophageal gastrostomy (PTEG) placement and the management of the pre-, peri-, and postoperative considerations in patients with malignant bowel obstruction (MBO).

Background: MBO is a relatively common complication of advanced intra-abdominal malignancy with significant effects on quality of life {1}. A PTEG offers a more comfortable alternative than a nasogastric tube for patients with contraindications to primary gastrostomy tube placement {2}.

Clinical Findings/Procedure Details: The primary indication for PTEG is MBO relieved by nasogastric/orogastric tube decompression with contraindication to a primary transabdominal gastric tube placement. Contraindications leading to PTEG placement include but are not limited to anterior peritoneal/gastric malignancy, prior gastrectomy, intractable ascites, and anterior loops of bowel that cannot be mobilized or decompressed {3}. The procedure is typically performed with palliative intent, and less often for enteral nutrition.

The PTEG procedure is performed under fluoroscopic and ultrasound guidance with supplies commonly available in many interventional radiology departments {4-5}. Initially, under fluoroscopic guidance, a 20 mm contrast filled balloon is placed within the esophagus, just inferior to the upper esophageal sphincter. The balloon serves as a target for ultrasound-guided percutaneous needle access for subsequent wire placement into the stomach, with the carotid space being splayed apart using targeted manual pressure with the ultrasound probe for safe traversal of the subcutaneous tissues. The balloon is then removed prior to dilation up to 12-14 Fr for accommodation of a 45 cm or 60 cm pigtail catheter.

Adequate post-procedural management is key to procedural success including regular decompression, routine catheter flushes, and purposeful advancement to a limited oral diet. Common complications in the peri- and postoperative setting include infection, tube clogging and malposition. This exhibit will include details of our institutional experience with 27 patients.

Conclusion and/or Teaching Points: The number of patients who can benefit from PTEG placement is expanding, though many IR providers are not familiar with these tubes. This educational review will help providers become more confident with PTEG placement and management.