Unsedated transnasal percutaneous endoscopic gastrostomy placement in selected patients.

BACKGROUND AND STUDY AIMS: The placement of a percutaneous endoscopic gastrostomy (PEG) is the procedure of choice for the long-term management of dysphagic patients with neurological disease or with trauma or tumors of the head and neck. It is not always possible to perform conventional upper gastrointestinal endoscopy in such patients due to stenosis and/or occlusion of the mouth or pharynx and/or partial or complete trismus. The aim of this study was to show whether transnasal esophagogastroduodenoscopy (EGD) offers a feasible and effective alternative method for PEG placement in these selected patients. PATIENTS AND METHODS: PEG placement was required for 155 patients at our institution during a 27-month period. In 12 patients oral access of an endoscope into the esophagus was not possible. Unsedated transnasal EGD (T-EGD) was then performed using an ultrathin video gastroscope, which had a distal-end diameter of 5.9 mm. A 16-Fr polyurethane PEG tube with a conical, flexible, soft distal end and a collapsible bumper was used in all cases. The Gauderer-Ponsky pull technique was used for PEG placement. RESULTS: T-EGD and perendoscopic transnasal placement of a PEG tube was successfully performed in all 12 patients. No patient required sedation during the procedure. No immediate or late-onset procedure-related complications occurred in any of the 12 patients. CONCLUSIONS: In some dysphagic patients in whom the oral route is not accessible with a standard endoscope, a transnasal endoscopic approach allows the placement of a PEG tube. In these selected patients this technique has been shown to be safe and effective and does not require the use of sedation.

[Double-contrast esophagography in the diagnosis of esophagitis due to Candida. A study on HIV-seropositive patients]. / L'esofagografia a doppio contrasto nella diagnosi di esofagite da Candida. Studio su pazienti sieropositivi per HIV.

This study was aimed at assessing the sensitivity of double-contrast esophagography in diagnosing Candida esophagitis. This condition accounts for 85% of all esophageal infections in the subjects suffering from AIDS. Thirty-nine HIV+ patients were evaluated: 19 of them had endoscopic diagnosis of Candida esophagitis. Our study confirmed the high sensitivity of esophagography (90%), as reported in the literature. Radiographic findings were edematous esophageal folds in the early stage and, subsequently, plaques and diffuse ulcerations. These patterns are suggestive of anatomical lesions: in the early stage, mucosal edema and erythema are observed, and later on pseudomembranes and ulcerations. None of our patients exhibited stenosis. All the subjects with Candida esophagitis had less than 250/mm3 of CD4 lymphocytes. In conclusion, double-contrast esophagography must be included in the periodic examinations performed on patients with AIDS, so as to allow an early diagnosis.