Fig. 2. Placing a gastrostomy tube in patient with nondistended stomach due to complete esophageal obstruction. (A) Passing a guidewire (arrows) through the stricture is impossible. (B) A Chiba needle (arrows; Cook, USA) is used to puncture the nondilated stomach under ultrasonographic guidance (not shown). Contrast is injected through the Chiba needle, and the image shows the spread of contrast medium in the nondistended stomach. (C) Insertion of a 0.018″ microguidewire (arrows) via the Chiba needle (arrowheads) into the stomach. (D) Insertion of a 6-Fr Neff catheter (arrows) over the microguidewire. The stomach is air-inflated through the Neff catheter (Cook). (E) The anchor (arrowheads) is pushed with a 0.035″ guidewire (arrow) through the Neff catheter. The Neff catheter is subsequently removed. (F) Gastrostomy catheter is successfully inserted after serial dilation of the tract.
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