Novel use of esophageal overtube and water flushes as a safety indicator and facilitator for the push technique in esophageal food impaction

Esophageal food impaction requires urgent endoscopic intervention either by extraction or pushing into the stomach.Due to risks of perforation,controversy exists between when to extract verses when to push the food bolus.There are no clear guidelines on when it is safe to push a food bolus;endoscopists rely on their subjective experiences and judgment.We present a case with a novel use of an esophageal overtube and water flushes to determine the safety of pushing a food bolus and facilitate passage into the stomach.

Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently

Gastrostomy tube is an effective and safe long-term feeding access that is welltolerated by patients.The typical placement routes include surgical,endoscopic and interventional radiologic placement.In particular,percutaneous interventional radiologic gastrostomy(PIRG)has increasingly become the preferred method of choice in many practices.Although many PIRG techniques have been developed since the 1980s,there is still a paucity of evidence supporting the choice of a most-optimal PIRG technique.Hence,there is a large variation in institutional approach to PIRG.We are a large,quaternary academic institution with an extensive experience in PIRG.Therefore,we aim to present the“push”PIRG technique utilized in our institution,to review the current literature,to discuss the optimal choice of PIRG technique and to generate further interests in comparison studies.