Gastrostomy placement : when fluoroscopy helps the endoscopist.

BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy is the most common therapeutic procedure performed by the digestive endoscopists in the upper gastrointestinal tract. It aims to feed patients presenting denutrition and/or insufficient oral intake. Percutaneous endoscopic gastrostomy feasibility is about 95-100 % although in some cases it is impossible to achieve it, leading to ask for a surgical placement. Even though the feasibility of the surgical approach is excellent its complications are quite higher than percutaneous endoscopic placement, it requires general anesthesia and sometimes these patients could be non elligible for it due to their comorbidities (malnutrition, cardio-vascular diseases etc.). Another alternative technique is the percutaneous radiological gastrostomy but this procedure is rarely available in our country. PATIENTS AND METHODS: We described four cases in patients with previous failure of PEG, in which we used an hybrid approach between radiological and endoscopic techniques, allowing the placement of gastrostomy tube, without general anesthesia. RESULTS: This was successful in all patients and there was no complication related to the procedure. CONCLUSIONS: This technique offers an additionnal opportunity to avoid general anesthesia and surgical complications in patients with unfavorable conditions.

Uncommon cause of retrosternal pain.

We present the case of a 54-year old male patient who was admitted with severe acute epigastric pain, vomiting, and inability to eat since three days before admission. After having excluded cardiac and pulmonary emergencies, an oesogastroduodenoscopy was planned and showed a gastric volvulus. The patient was treated surgically allowing gastric decompression, gastropexy and Nissen intervention. We discuss the case and describe the classification, the diagnosis, the etiologies and therapeutic options in acute and chronic gastric volvulus.