Percutaneous Endoscopic Gastrostomy Tube Gone Wrong: Endoscopic Closure to the Rescue

AbstractPercutaneous endoscopic gastrostomy (PEG) is one of the most commonly performed endoscopic procedures and a first-line treatment for the establishment of enteral access in those with intolerance or contraindication to oral feedings. A small amount of pneumoperitoneum in the immediate postprocedure period is well reported after PEG tube placement. However, pneumoperitoneum resulting from displaced gastric bumper within 24 hours postprocedure is uncommon and rarely reported in the literature. Timely diagnosis and early endoscopic management can help tackle such an unusual complication.

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A novel device for the endoscopic management of buried bumper syndrome

Endoscopy ◽

10.1055/a-0833-8516 ◽

2019 ◽

Vol 51 (07) ◽

pp. 689-693 ◽

Cited By ~ 4

Author(s):

Pieter Hindryckx ◽

Barbara Dhooghe ◽

Andreas Wannhoff

Keyword(s):

Abdominal Pain ◽

Gastric Mucosa ◽

Percutaneous Endoscopic Gastrostomy ◽

Endoscopic Management ◽

First Line ◽

Off Label ◽

Novel Device ◽

Endoscopic Gastrostomy ◽

Buried Bumper Syndrome ◽

Peg Tube

Abstract Background Buried bumper syndrome (BBS) is a complication of percutaneous endoscopic gastrostomy (PEG) in which the internal bumper is overgrown by the gastric mucosa. Apart from loss of patency of the PEG tube, the buried bumper may evoke symptoms such as abdominal pain or peritubular leakage. While the management of an incompletely buried bumper is fairly straightforward, this is not the case for a completely buried bumper. Different approaches to remove completely buried bumpers have been described, including endoscopic knife- or papillotome-based techniques. However, these devices are used off-label and the procedures can be laborious. Methods The Flamingo device has recently been introduced as the first tool specifically designed to remove a completely buried bumper. Results We describe the technique and our first experience in five patients with a completely (n = 4) or almost completely (n = 1) buried bumper. Fast and save removal of the buried bumper was obtained in all patients. Conclusion We believe that this device has the potential to become the standard first-line tool for the management of completely buried bumpers.

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1897 Endoscopic Closure of GastroColoCutaneous Fistula: A Rare Complication of Percutaneous Endoscopic Gastrostomy Tube Placement

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000597120.85040.ee ◽

2019 ◽

Vol 114 (1) ◽

pp. S1060-S1061

Author(s):

Hassaan Zia ◽

Maham Hayat ◽

Ralph Guild

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Rare Complication ◽

Gastrostomy Tube ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Endoscopic Gastrostomy ◽

Endoscopic Closure ◽

Gastrostomy Tube Placement

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Safety and efficacy of percutaneous endoscopic gastrostomy tube placement in patients with malignant peritoneal carcinomatosis induced bowel obstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14012 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14012-e14012

Author(s):

Pankaj G Vashi ◽

Donald Peter Braun ◽

Brenten Popiel ◽

Digant Gupta

Keyword(s):

Peritoneal Carcinomatosis ◽

Bowel Obstruction ◽

Percutaneous Endoscopic Gastrostomy ◽

Insertion Site ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Safety And Efficacy ◽

Symptom Resolution ◽

Endoscopic Gastrostomy ◽

Peg Tube

e14012 Background: Percutaneous Endoscopic Gastrostomy (PEG) tube placement in advanced peritoneal carcinomatosis with bowel obstruction is a feasible palliative procedure to help patients with obstructive symptoms. We describe the safety and efficacy of using PEG tube for decompression in patients with large peritoneal masses. Methods: A consecutive case series of 62 patients (Apr-08 to Jun-11) with advanced abdominal carcinomatosis induced bowel obstruction. All patients were extensively treated for their cancer. None of them were surgical candidates due to extensive peritoneal involvement. All patients had symptoms of nausea, vomiting and pain at the time of PEG tube placement. All patients had a 28F (Bard) PEG tube placed for drainage. The primary outcomes of interest were complications and symptom resolution due to PEG tube placement. Frequency of nausea, vomiting and severity of pain was recorded daily in patient charts. Results: 16 were males and 46 females. The mean age was 50.5 years. Most common cancers were ovary, pancreas, colon and stomach. Of 62 patients, 57 patients had expired at the time of this analysis. Of those 57 expired, 49 had PEG tube at the time of death, while 8 had complete resolution of symptoms with PEG tube removed before death. The 5 out of 62 patients who are alive still have the PEG tube for drainage (average 70.4 days). The average duration of PEG tube placement for all patients combined was 70.9 days (range 6-312 days). Relief of nausea, vomiting and pain was observed in 53 (85.5%), 55 (88.7%) and 35 (56.5%) patients respectively. Of a total of 43 patients who had PEG tube placed for >= 30 days, 24 (56%) could continue with their chemotherapy cycles because of symptom resolution. Non life threatening complications of PEG tube placement were observed in 9 (14.5%) patients. 3 had infection at the insertion site, 2 had bleeding and 3 had leaking at the PEG tube site while 1 had aspiration. 6 (9.7%) patients required replacement of the PEG tube due to occlusion. Conclusions: Placement of PEG tube in presence of advanced peritoneal carcinomatosis is safe and effective in relieving obstructive symptoms as well as extending the period of active cancer therapy.

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Inadvertent Percutaneous Endoscopic Gastrostomy Tube Placement through the Transverse Colon to the Stomach Causing Intractable Diarrhea: A Case Report

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2011/849460 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

David T. Burke ◽

Andrew I. Geller ◽

Alexios G. Carayannopoulos ◽

Richard Goldstein

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Transverse Colon ◽

Delayed Diagnosis ◽

Tube Placement ◽

Common Mechanism ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Endoscopic Gastrostomy ◽

Tube Removal ◽

Peg Tube

Background. Among patients with chronic disease, percutaneous endoscopic gastrostomy (PEG) tubes are a common mechanism to deliver enteral feedings to patients unable to feed by mouth. While several cases in the literature describe difficulties with and complications of the initial placement of the PEG, few studies have documented the effects of a delayed diagnosis of a misplaced tube. Methods. This case study reviews the hospitalization of an 82 year old male with an inadvertent placement of a PEG tube through the transverse colon. Photos of the placement in the stomach as well as those of the follow up colonoscopy, and a recording of the episodes of diarrhea during the hospitalization were made. Results. The records of this patient reveal complaints of gastrointestinal distress and diarrhea immediately after placement of the tube. Placement in the stomach was verified by endoscopy, with discovery of the tube only after a follow up colonoscopy. The tube remained in place after this discovery, and was removed weeks after the diarrhea was unsuccessfully treated with antibiotics. After tube removal, the patient recovered well and was sent home.

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Buried Bumper Syndrome Revisited: A Rare but Potentially Fatal Complication of PEG Tube Placement

Case Reports in Critical Care ◽

10.1155/2014/634953 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Saptarshi Biswas ◽

Sujana Dontukurthy ◽

Mathew G. Rosenzweig ◽

Ravi Kothuru ◽

Sunil Abrol

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Gastric Wall ◽

Late Complications ◽

Tube Placement ◽

Endoscopic Gastrostomy ◽

Enteral Access ◽

Delayed Complications ◽

Buried Bumper Syndrome ◽

Peg Tube

Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.

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Meningitis Due to Enterobacter aerogenes Subsequent to Resection of Acoustic Neuroma and Percutaneous Endoscopic Gastrostomy Tube Placement: A Rare Nosocomial Event

Infection Control and Hospital Epidemiology ◽

10.1086/502135 ◽

2003 ◽

Vol 24 (10) ◽

pp. 780-782 ◽

Cited By ~ 2

Author(s):

David M. Poetker ◽

Charles E. Edmiston ◽

Michelle M. Smith ◽

Glenn A. Meyer ◽

Phillip A. Wackym

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Acoustic Neuroma ◽

Enterobacter Aerogenes ◽

Intervention Strategies ◽

Gastrostomy Tube ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Endoscopic Gastrostomy ◽

Gastrostomy Tube Placement ◽

Peg Tube

AbstractWe present a case of meningitis after percutaneous endoscopic gastrostomy (PEG) tube placement subsequent to acoustic neuroma resection and cranioplasty. Four days following PEG tube placement the patient developed Enterobacter aerogenes meningitis, requiring explantation of infected cranioplasty material. His condition subsequently improved. Etiology and future intervention strategies are discussed (Infect Control Hosp Epidemiol 2003;24:780-782).

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Endoscopic Techniques for Obtaining Enteral Access

10.2310/gastro.9055 ◽

2017 ◽

Author(s):

Marvin Ryou ◽

Sanjay Salgado

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Enteral Feeding ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Nasogastric Feeding ◽

Percutaneous Gastrostomy ◽

Endoscopic Techniques ◽

Endoscopic Gastrostomy ◽

Enteral Access ◽

Gastric Feeding

In the absence of contraindications, enteral feeding is recommended for patients who are expected to be intolerant of oral feedings beyond 7 days. Enteral access can be accomplished by a variety of means, including surgical, endoscopic, or radiographic methods. This review focuses on endoscopy-guided options for enteral access. These methods include gastric feeding, which can be accomplished by orogastric, nasogastric, or percutaneous endoscopic gastrostomy tube placement, and postpyloric feeding, accessed through oral or nasal jejunal tubes, percutaneous gastrostomy with a jejunal extension, or direct percutaneous jejunostomy. The indications, techniques, complications, and comparative data of these placement options are outlined, and special clinical considerations (including establishing access in patients with dementia or cirrhosis and those on anticoagulation) are discussed. This review contains 5 figures, 1 table, and 33 references. Key words: direct percutaneous jejunostomy, endoscopy, enteral access in cirrhosis, enteral access in dementia, enteral feeding, enteric access, nasogastric feeding tubes, percutaneous endoscopic gastrojejunostomy tubes, percutaneous endoscopic gastrostomy tubes

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Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement after Stroke

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100016218 ◽

2014 ◽

Vol 41 (1) ◽

pp. 24-28 ◽

Cited By ~ 5

Author(s):

Jian Li ◽

Juan Zhang ◽

Shujuan Li ◽

Hongliang Guo ◽

Wei Qin ◽

...

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Univariate Analysis ◽

Swallowing Disorders ◽

Tube Placement ◽

Lesion Volume ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Nihss Score ◽

Endoscopic Gastrostomy ◽

Peg Tube ◽

Bilateral Lesions

Aims:the goal of this study was to identify important prognostic variables affecting placement of a percutaneous endoscopic gastrostomy (Peg) tube after acute stroke.Methods:We retrospectively reviewed our patient database to identify acute ischemic stroke patients who placed Peg or nasogastric tube (Ngt) tube, but were free of other confounding conditions affecting swallowing. A total of 340 patients were involved in our study. We assessed the influence of age, National Institutes of Health stroke scale (NIHss) score, infarct volume, stroke subtype based on the toAst criteria, swallowing disorders, bilateral lesions in cerebrum and length of stay (los) in a logistic regression analysis.Results:In univariate analysis, age (p=0.048), NIHss score (p<0.0001), lesion volume (p<0.0001), los (p<0.0001), stroke location (p=0.045), and swallowing disorders (p<0.0001) were found to be the primary predictors of placing Peg. the presence of lesions in bilateral cerebral was included in the final model based on clinical considerations. After multivariate adjustment, only NIHss score (odds ratio [oR], 4.055; 95% confidence interval [CI], 2.398-6.857; p=0.0001), lesion volume (oR, 1.69; 95%CI, 1.09–4.39; p=0.014), swallowing disorders (oR, 1.151; 95% CI, 1.02-1.294; p=0.047), los (oR, 0.955; 95% CI, 0.914-0.998; p=0.0415) and bilateral lesions (oR, 2.8; 95% CI, 1.666-4.705; p=0.0001) remained significant.Conclusion:our data shows that NIHss score, lesion volume, swallowing disorders, los and bilateral lesions in cerebrum can predict the requiring of Peg tube insertion in patients after stroke.

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Bronchoscope-Guided Percutaneous Endoscopic Gastrostomy Tube Placement by Interventional Pulmonologists: A Feasibility and Safety Study

Journal of Intensive Care Medicine ◽

10.1177/0885066618800275 ◽

2018 ◽

Vol 35 (9) ◽

pp. 851-857 ◽

Cited By ~ 1

Author(s):

Erik Folch ◽

Fayez Kheir ◽

Amit Mahajan ◽

Daniel Alape ◽

Omar Ibrahim ◽

...

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Percutaneous Tracheostomy ◽

Gastrostomy Tube ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Endoscopic Gastrostomy ◽

Increased Risk ◽

Tube Removal ◽

Gastrostomy Tube Placement ◽

Peg Tube

Background: Percutaneous endoscopic gastrostomy (PEG) tube placement is a procedure frequently done in the intensive care unit. The use of a traditional endoscope can be difficult in cases of esophageal stenosis and theoretically confers an increased risk of infection due to its complex architecture. We describe a technique using the bronchoscope, which allows navigation through stenotic esophageal lesions and also minimizes the risk of endoscopy-associated infections. Methods: Prospective series of patients who had PEG tube placement guided by a bronchoscope. Procedural outcomes including successful placement, duration of the entire procedure, time needed for passage of the bronchoscope from the oropharynx to the major curvature, PEG tube removal rate, and mortality were collected. Procedural adverse events, including infections and long-term PEG-related complications, were recorded. Results: A total of 84 patients underwent bronchoscope-guided PEG tube placement. Percutaneous endoscopic gastrostomy tube insertion was completed successfully in 82 (97.6%) patients. Percutaneous endoscopic gastrostomy tube placement was performed immediately following percutaneous tracheostomy in 82.1%. Thirty-day mortality and 1-year mortality were 11.9% and 31%, respectively. Overall, minor complications occurred in 2.4% of patients, while there were no major complications. No serious infectious complications were identified and no endoscope-associated hospital acquired infections were documented. Conclusions: The use of the bronchoscope can be safely and effectively used for PEG tube placement. The use of bronchoscope rather than a gastroscope has several advantages, which include the ease of navigating through complex aerodigestive disorders such as strictures and fistulas as well as decreased health-care utilization. In addition, it may have a theoretical advantage of minimizing infections related to complex endoscopes.

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