Modified Radiology-Guided Percutaneous Gastrostomy (MRPG) for Patients with Complete Obstruction of the Upper Digestive Tract and Who are without Endoscopic or Nasogastric Access

OBJECTIVE: We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract. MATERIALS AND METHODS: Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fluoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fluoroscopic guidance) was performed in these patients. RESULTS: We achieved successfully percutaneous gastrostomy using the modified technique in all patients without any major or minor complications after the procedure. CONCLUSION: A modified radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract.

A Case of Takaysu Arteritis Associated with Complete Obstruction of Descending Thoracic Aorta and Stenosis of the Right Coronary Artery

Takaysu arteritis is a systemic disease characterized by stenosis or obstruction of aorta and its branches. Its etiology is unknown but clinical and serologic data suggest autoimmune process. Coronary artery involvement has been uncommon, but potentially fatal complication of Takayasu arteritis. A 41-year old female patients was presented with exertional dyspnea and anterioi chest pain of 2 week duration. Systolic bruit was heard at the both middle portion of internal carotid artery areas. Both radial arteries were palpated well but both femoral, popliteal and doralis pedis arteries were palpated weakly. Aortogram showed complete obstruction of descending thoracic aorta and collateral circulation of internal mammary artery. Coronary angiogram showed 80% stenosis at the middle portion of the right coronary artery. Calcium channel blocker and antiplatelet agent were prescribed. And her clinical symptom improved.