Endoscopic replacement of a transgastric feeding tube in advanced oropharyngeal cancer with esophageal obstruction using transgastrostomy endoscopy

A 78-year-old man with advanced oropharyngeal cancer presented with a therapy-resistant wound infection at the site of a previously placed percutaneous endoscopic gastrostomy (PEG). The infection required PEG-tube removal, performed using the cut-and-push technique. Owing to complete esophageal obstruction, conventional transoral endoscopic re-insertion of a new PEG was not feasible. ([Fig. 1]).

Fig. 1 An infected gastrostomy site with purulent discharge and abdominal wall phlegmon.

A slim nasal gastroscope was advanced through the gastrostomy tract to access the stomach ([Fig. 2]). Under direct endoscopic visualization, a new gastric puncture was performed in an unaffected region, followed by gastropexy and PEG reinsertion via the push technique. The procedure was carried out under sterile conditions without any complication ([Video 1]).

Fig. 2 A trans-gastrostomy endoscopic approach using a nasal gastroscope through the gastrostomy tract to access the stomach.

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A trans-gastrostomy endoscopic approach in a patient with complete esophageal obstruction. The nasal gastroscope was introduced via the gastrostomy tract, and a new PEG was safely placed under direct visualization.Video 1

Trans-gastrostomy PEG placement is a valuable alternative in patients with complete esophageal obstruction where conventional access is impossible. Careful patient selection and strict adherence to sterile technique enable the safe reinsertion of a PEG at a new gastric site, avoiding the need for surgical gastrostomy.

This case illustrates the feasibility and safety of trans-gastrostomy endoscopy for PEG replacement in complex anatomical situations and highlights its role as a minimally invasive salvage technique.

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Contributorsʼ Statement

Ahmed Alwali: Conceptualization, Investigation, Writing – original draft, Writing – review & editing. Clemens Eissner: Data curation, Investigation, Writing – review & editing. Imad Kamaleddine: Investigation, Writing – review & editing. Clemens Schafmayer: Supervision, Writing – review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

Publication History

Article published online:
13 January 2026