PERCUTANEOUS ENDOSCOPIC GASTROSTOMY-JEJUNOSTOMY (PEG-J) USING A DOUBLE LUMEN GASTROJEJUNAL TUBE FOR PYLORIC STENOSIS OF GASTRIC CANCER

Abstract

Percutaneous endoscopic gastrostomy (PEG) is now the most common method of enteral nutrition in patients who require long-term tube feeding. Another aim of PEG is decompression for patients with stenotic diseases. A Japanese male in his nineties was admitted under a diagnosis of advanced gastric cancer with pyloric stenosis. Although he frequently vomited, he and his family refused surgical treatment, including gastric bypass surgery. In order to achieve both nutrition support and decompression simultaneously, a percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) was planed. The PEG-J was scheduled in two steps and the second step involving placement of a gastrojejunal double lumen tube was performed using transgastronomic endoscopy (TGE) one week after the PEG. This tube can feed nutritional solution from the jejunal lumen and can drain gastric juice from a hole in the stomach. The patient could therefore be discharged, avoiding uncomfortable treatments, such as nasal gastric tube drainage and intravenous hyperalimentation from a central vein catheter. We think that PEG-J using a gastrojejunal double lumen tube might be an option for malignant pyloric stenosis.