Reply to Clark and Pugash

We are grateful to Dr. Clark and Dr. Pugash for their interest in our article [1] and for their information about the possibility of radiological gastrostomy.

We did not include this little-used technique in our discussion, as in one crucial point it does not differ from percutaneous endoscopic gastrostomy (PEG), the standard procedure for establishing gastrostomies. To carry out a radiological gastrostomy with the usual technique, it is also necessary to pass the pharynx and esophagus [2] [3] [4]. Exactly this situation was not the case in the patients we described, who were treated using laparoscopic Janeway gastrostomy.

The technique of carrying out radiologic gastrostomy without tube passage of the pharynx and esophagus, which is mentioned in the letter, has only been reported in a few cases to our knowledge [5], and may be associated with a variety of possible complications. Currently, the only safe methods of establishing gastrostomies in patients with complete obstruction of the upper esophagus are still surgical procedures such as the laparoscopic Janeway gastrostomy.

The statement by Clark and Pugash that surgical techniques, including laparoscopy, are the only invasive ones, is incorrect. Radiologic gastrostomy is also an invasive technique. Complication rates of 4.2 - 12.9 % and reports of procedure-related deaths after radiologic gastrostomies underline this [2] [3] [4].

We still consider that the laparoscopic Janeway gastrostomy is the best and safest method of achieving palliative feeding access in patients with impassable tumors of the pharynx and esophagus.

References

• 1 Raakow R, Hintze R, Schmidt S. et al . The laparoscopic Janeway gastrostomy: an alternative technique when percutaneous endoscopic gastrostomy is impractical.  Endoscopy. 2001;  33 610-613
• 2 Clark J A, Pugash R A, Pantalone R R. Radiologic peroral gastrostomy.  J Vasc Interv Radiol. 1999;  10 927-932
• 3 Dell S D, Carmody E A, Yeung E Y. et al . Percutaneous gastrostomy and gastrojejunostomy: additional experience in 519 procedures.  Radiology. 1995;  194 817-820
• 4 Ryan J M, Hahn P F, Boland G W. et al . Percutaneous gastrostomy with T-fastener gastropexy: results of 316 consecutive procedures.  Radiology. 1997;  202 496-500
• 5 Pugash R A, Brady A P, Isaacson S. Ultrasound guidance in percutaneous gastrostomy and gastrojejunostomy.  Can Assoc Radiol J. 1995;  46 196-198