The Application Of The Introducer Technical PEG Combined With Esophageal Dilation In Strictures Of Esophagus

Objective: To observe the safety and practicability of the application of introducer technical percutaneous endoscopic gastrostomy(introducer-PEG)combined with esophageal dilation in providing effective long-term access to enteral nutrition(EN)for benign and malignant strictures of esophagus.Methods: From June 2015 to May 2017,we collected 6 cases who admitted to the department of gastroenterology in the First Affiliated Hospital of Soochow University for esophageal strictures.Four cases of esophageal carcinoma,a case with postoperative esophageal stricture even with repeated stents,and a case with restenosis after stent implantation caused by metastasis involved.Blood coagulation,blood routine,ECG,etc.,were carried to eliminate contraindications.Patients gave their informed consent.Under the guidance of X-ray fluoroscopy and endoscope,and confirmed by contrast,the strictures of esophagus were dilated carefully till ultrafine gastroscope could go through.The distribution of the contrast agent,bleeding and the pain of patients were observed during the expansion.Sedation and analgesia were applied in patients after dilation.Then,the introducer-PEG was conducted by ultrafine gastroscope.Relevant postoperative managements included electro cardio-monitoring,inhaling oxygen,acid suppression and so on.Attentions should pay for the occurrence of chest pain,hematemesis,hemafecia,bellyache,stoma,etc.Postpone feeding until the following day,from normal saline to nutrient.Dress daily,examine the stoma site,and take out the suture 15 days later.The procedure time,tolerance,complications,etc.,were observed.Results: Dilation was conducted in all cases,with success rate of 100%(6/6).Time of dilation was 14.5±3.1min(with diameter 10mm),without tearing,perforation or bleeding.The introducer-PEG succeed in all cases(6/6),operating time ranged from 10.9 to 16.1min(13.1±2.1mins).There was no peritonitis,abdominal organ injury or wound infection occurred.Nutrient was injected followed normal saline 24 h after PEG,without discomfort(like abdominal distention,or diarrhea).Patients mastered the feeding and nursing method well,5 cases had their own life with better quality.And all discharged with the PEG tubes without dislodgment or obstruction.Radiotherapy was well conducted in a case without interference from PEG tube.6 cases returned and exchanged a new PEG tube via a guide wire 3 months later.Stomal infection in a case was cured with local care.6 months later,4 cases exchanged the tube twice,no displacement or occlusion occurred during the follow-up.Conclusion: The introducer-PEG combined with esophageal dilation is a safe,practical and feasible method to provide long term EN for benign or malignant esophageal strictures.Patients would be self-reliant to accomplish feeding.The introducer-PEG may be widely used for simple manipulation,practical,and less complications.