Percutaneous endoscopic gastrostomy to treat upside-down stomach before stent insertion in a patient with distal esophageal carcinoma

A 89-yr-old woman presenting with dysphagia due to an obstructing adenocarcinoma of the distal esophagus was additionally diagnosed to have an upside-down stomach creating a sharp angulation at the esophagogastric junction. Gastric anatomy had to be restored before palliative stent insertion. As the patient was judged unfit for surgery, the stomach was repositioned endoscopically and fixed to the abdominal wall by percutaneous endoscopic gastrostomy. In the same sitting, a metal stent was placed. Effective palliation of dysphagia was achieved until the patient died of an unrelated cause 5 months later.