TRANSTHORACIC PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) AFTER ESOPHAGECTOMY AND GASTRIC PULL-UP

The technique of transthoracic percutaneous endoscopic gastrostomy (PE G) tube placement is described as an alternative to standard nasogastr ic tube drainage and inpatient observation for those patients who requ ire gastric decompression after esophagectomy with gastric pull-up. In dications for transthoracic PEG tube insertion are distention and poor emptying of the intrathoracic stomach conduit with or without contain ed anastomotic leak, especially when it appears as if the problem will be slow to resolve. This technique is not advocated for patients with free anastomotic leaks. The potential advantages of this technique ov er standard nasogastric drainage are that it permits stable patients t o be treated successfully as outpatients.