Describe the feasibility and safety of retrograde esophageal and stomach tubing for palliative drainage

Retrospective single-center cohort study

Between 2022 and 2025, six pediatric and adult patients underwent a novel retrograde placement of gastrojejunostomy (GJ) tubes into the esophagus to provide continuous palliative drainage of esophageal secretions. The cohort included cases of familial dysautonomia–associated megaesophagus, post-surgical strictures, and malignant esophageal stenosis (Table). Using a slim endoscope, GJ tubes were introduced over a guidewire and advanced retrogradely across the stenotic segment, allowing drainage of the proximal stomach or esophagus through the J-port, while gastric feeding was maintained through the G-port.

All procedures were completed successfully without technical difficulties or complications. Following placement, the nasogastric tube was removed, and the GJ tube effectively alleviated esophageal content pooling. An illustartion of the procedure is provided.

Despite being performed in high-risk patients, most procedures were feasible without sedation, thereby reducing risk and obviating the need for anesthesiology support. Moreover, tube replacement over a guidewire can be safely performed during a routine clinic visit.

Table: profile of patients treated with retrograde esophageal tubing

This case series demonstrates the feasibility, safety, and reproducibility of retrograde transgastric esophageal tubing as a palliative solution for refractory esophageal stasis.

Our findings highlight an unmet need in palliative gastroenterology, suggesting that this technique can significantly improve patient comfort and reduce aspiration risk.