Transgastrostomal Observation and Management Using an Ultrathin Endoscope After Percutaneous Endoscopic Gastrostomy

Recent developments have made ultrathin endoscopes available for routine esophagogastroduodenoscopy and also for unsedated transnasal observation (Shaker, 1994). Transnasal endoscopy is known to be less of a burden for patients (more tolerable) than transoral endoscopy and has benefits including fewer effects on respiratory and cardiovascular status and reduced recovery time after the procedure (Campo et al., 1998; Dumortier et al., 1999; Mori et al., 2008). Transnasal ultrathin endoscopy has also been applied for biliary drainage, insertion of a nasoenteral feeding tube or a long intestinal tube, and percutaneous endoscopic gastrostomy (PEG) (Fang et al., 2005; Itoi et al., 2008; Sato et al., 2008; Vitale et al., 2005). PEG has become the primary access for long term enteral feeding since its introduction in 1980 (Gauderer et al., 1980; Ponsky & Gauderer, 1981), being a very easy and rapid method compared with the previous surgical technique to place a gastrostomy tube. The endoscopic approach from the gastrocutaneous tract was first described by Chaurasia , et al. for the insertion of a jejunal feeding tube through the PEG (PEG-J) tract (Chaurasia & Chang, 1995). Although they used a pediatric bronchoscope at that time, an ultrathin endoscope later took its place for this purpose (Adler et al., 2002). We have been employing an ultrathin endoscope through the gastrostomy tract for observation, diagnosis, and treatment of various digestive diseases from April 2003. We also investigated the usefulness of such transgastrostomal endoscopy (TGE) for management of patients who had undergone percutaneous endoscopic gastrostomy (PEG).