Cyanoacrylate injection to treat recurrent bleeding from Dieulafoy's lesion.

a new, over-the-wire technique for SLG tube placement during a single, same-day endoscopic procedure. First, we identify the existing fistula between the skin and the gastric body. We gently probe the gastrostomy tract and establish it with a guidewire under direct endoscopic vision. We grasp the guidewire with an endoscopic snare and withdraw it through the mouth in a standard manner. Second, we pass a stoma measuring device over the wire to measure the tract length. This is a vital step because tracts can elongate over time, and the true tract length can differ from the initial marking at the external bolster. After measurement, we remove and discard the stoma measuring device. Third, we insert a push-type gastrostomy tube over the oral side of the guidewire to dilate the tract, dragging the push-type gastrostomy tube only so far that the internal bolster remains at the patient’s mouth. We then cut the dilating plastic portion of the push gastrostomy tube at an appropriate spot, taking care not to damage the guidewire within. After discarding the dilating portion of the tube, we pass the SLG tube over the wire and engage it over the cut plastic end of