Second look endoscopy by a laryngo-fiberscope passed via the feeding tube of the percutaneous endoscopic gastrostomy.

The most commonly used techniques for percutaneous endoscopic gastrostomy (PEG) require two passes of the gastroscope. The aim of this study was to clarify whether the second per oral gastroscopy can be replaced by passing a laryngo-fiberscope through the previously inserted PEG feeding tube. Twelve patients with head and neck cancer undergoing "pull through" PEG procedures were included in this prospective study. Instead of the second per oral pass of the gastro-intestinal fiberscope, a laryngo-fiberscope was passed through the inserted feeding tube to assess the correct position of the PEG internal disc. To gain more deflection to the tip of the instrument a string was led through the instrument channel and was brought back to the hand of the examiner outside the instrument. Pulling the string provided a bigger angulation to the end of the scope and thus a good view. In all twelve patients the "trans tubal" endoscopy was successful and provided a good second look to judge the position PEG internal disc. The procedure caused no inconvenience for the patient. "Trans tubal" endoscopy is a simple, safe and painless procedure to assess the position of the PEG feeding tube without having to pass the gastro-intestinal fiberscope a second time.