Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer

Figure 1 Direct method. A: The transilluminated area on the abdominal wall was pushed with a finger; B, C: The stomach was punctured using a double-lumen gastropexy device; D: A needle with an outer plastic sheath (18-French) was introduced into the stomach under endoscopic control; E: The needle was removed and the guidewire was replaced; F, G: The skin incision was dilated by passing a dilator percutaneously into the stomach over the guidewire under endoscopic visualization; H: After the dilator was removed, a 24-French percutaneous endoscopic gastrostomy tube using an obturator was inserted over the guidewire; I: The tube was fixed to the abdominal wall.

Figure 2 Algorithm of percutaneous endoscopic gastrostomy for aerodigestive cancer. CRT: Chemoradiation therapy; Ce: Cervical esophagus; Ut: Upper thoracic esophagus; Mt: Middle thoracic esophagus; Lt: Lower thoracic esophagus; PEG: Percutaneous endoscopic gastrostomy.