Feasibility and Safety of Overtubes for PEG-Tube Placement in Patients with Head and Neck Cancer

Figure 2

Step-by-step directions for positioning overtube. (a) Guardus overtube with correct snug fit of scope. (b) The inner and outer surfaces of both tubes are generously lubricated using a water-soluble lubricant (not water). (c) The fully lubricated inner tube is inserted into the fully lubricated outer tube and “backloaded” onto the scope, positioning the assembled Guardus overtube at the proximal end of the scope. (d) After performing baseline esophagoscopy, the overtube assembly is gently inserted into the esophagus through the bite block (use of a 60 F bite block is recommended). The inner tube and scope are then simultaneously removed, leaving the outer tube in place. (e) The insufflation cap is attached. This minimizes backflow of bodily fluids and maintains insufflation throughout the procedure. (f) The scope is reintroduced through the insufflation cap into the stomach (courtesy of US Endoscopy, Mentor, OH). PEG placement then proceeds using the standard Guederer-Ponsky “pull” technique, with the catheter pulled through the outer overtube still maintained in the esophagus.

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