The technique of transthoracic percutaneous endoscopic gastrostomy (PEG) tube placement is described as an alternative to standard nasogastric tube drainage and inpatient observation for those patients who require gastric decompression after esophagectomy with gastric pull-up. Indications for transthoracic PEG tube insertion are distention and poor emptying of the intrathoracic stomach conduit with or without contained anastomotic leak, especially when it appears as if the problem will be slow to resolve. This technique is not advocated for patients with free anastomotic leaks. The potential advantages of this technique over standard nasogastric drainage are that it permits stable patients to be treated successfully as outpatients.
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