PEG and Esophageal Stent Insertion for Advanced Pulmonary Neoplasia

PEG placement and esophageal stent insertion in a 78-year-old patient with advanced pulmonary neoplasia and dysphagia.

Procedure Steps:

PEG Placement:

1. Perform transillumination to identify the appropriate insertion site.

2. Puncture the abdominal wall at the identified site.

3. Pass a guidewire into the stomach and capture it using a snare.

4. Insert the PEG tube securely into position.

Esophageal Stent Insertion:

1. Place metallic markers on the thoracic wall, one at the proximal end and another at the distal end of the stricture, using fluoroscopy with or without an endoscopic view. If the stricture cannot be crossed, perform this step under fluoroscopy after injecting contrast.

2. Measure the length of the stricture to determine the appropriate stent length.

3. Pass a guidewire through the stricture, ensuring the formation of large loops in the stomach under fluoroscopy for stability.

4. Advance the stent through the stricture, aligning it using the radio-opaque markers on the stent and the metallic markers on the thoracic wall.

5. Release the stent gradually under fluoroscopy and, if applicable, endoscopic guidance, depending on whether the stent has a distal or proximal release system.

6. Conclude the procedure with a contrast injection to confirm proper stent placement and functionality.