To evaluate the feasibility and safety of water–air sequential infusion assisted Ultrasound-Guided Percutaneous Gastrostomy (UGPG) in a patient with complete esophageal obstruction.

A 72-year-old male patient with esophageal squamous cell carcinoma presented with complete esophageal obstruction and severe malnutrition. Endoscopic and fluoroscopic gastrostomy were not feasible, and the patient was unable to tolerate general anesthesia. A purely ultrasound-guided percutaneous gastrostomy was performed. The procedure consisted of initial infusion of a small volume of normal saline into the gastric antrum to facilitate identification of the gastric lumen and placement of a pigtail drainage catheter, followed by continuous air insufflation through the catheter to achieve adequate gastric distension and close apposition of the anterior gastric wall to the abdominal wall. Under real-time ultrasound guidance, gastric wall fixation and gastrostomy tube placement were successfully completed.

The procedure was completed smoothly with satisfactory gastric distension and a clear, safe puncture pathway. The gastrostomy tube was accurately positioned, and no perioperative complications, including bleeding, infection, or peritonitis, were observed. Enteral nutrition was initiated 24 hours after the procedure and was well tolerated.

Water–air sequential infusion–assisted UGPG is a feasible and safe alternative for gastrostomy in patients with complete esophageal obstruction who are unsuitable for endoscopic or fluoroscopic approaches. This radiation-free, minimally invasive technique avoids the need for general anesthesia and may represent a valuable option for high-risk or critically ill patients. Further studies with larger sample sizes are warranted to validate its clinical utility.